Provider Demographics
NPI:1538273644
Name:DEEM, MARK B (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:DEEM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:265 TANGLEWOOD LN
Mailing Address - Street 2:STE E-1
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498
Mailing Address - Country:US
Mailing Address - Phone:970-468-1003
Mailing Address - Fax:970-468-2196
Practice Address - Street 1:1080 S SABLE BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3796
Practice Address - Country:US
Practice Address - Phone:303-552-9577
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2025-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-00330207Q00000X
CODR.0059899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00411124OtherRR MEDICARE
NC5905080Medicaid
NC2403481Medicare ID - Type UnspecifiedCHUC PROSP CROSS