Provider Demographics
NPI:1144304767
Name:DOUTHIT, JOHN DAVEY JR (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVEY
Last Name:DOUTHIT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9981 N WASHINGTON ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:303-451-8069
Mailing Address - Fax:303-450-2372
Practice Address - Street 1:9981 N WASHINGTON ST
Practice Address - Street 2:NUMBER 24
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-451-8069
Practice Address - Fax:303-450-2372
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01350438Medicaid
C805058Medicare ID - Type Unspecified
CO01350438Medicaid