Provider Demographics
NPI:1912132556
Name:SPEEDIE, DOUGLAS KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KENNETH
Last Name:SPEEDIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10600
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-5600
Mailing Address - Country:US
Mailing Address - Phone:970-244-7761
Mailing Address - Fax:
Practice Address - Street 1:11485 HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:ECKERT
Practice Address - State:CO
Practice Address - Zip Code:81418-5204
Practice Address - Country:US
Practice Address - Phone:866-961-1451
Practice Address - Fax:866-406-1451
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine