Provider Demographics
NPI:1871576066
Name:WEBSTER, DOUGLAS S (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-203-7000
Mailing Address - Fax:970-203-7055
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:NORTH MOB
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-203-7000
Practice Address - Fax:970-203-7055
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01328764Medicaid
CO110159080OtherRAILROAD MEDICARE PTAN
COCO306192Medicare PIN
CO110159080OtherRAILROAD MEDICARE PTAN
CO01328764Medicaid
CO438786YLB8Medicare PIN