Provider Demographics
NPI:1760489058
Name:DULIT, ALAN M (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:DULIT
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 1:444 SHERWOOD TRAIL
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424
Mailing Address - Country:US
Mailing Address - Phone:970-390-6793
Mailing Address - Fax:
Practice Address - Street 1:340 PEAK ONE DRIVE
Practice Address - Street 2:POB 738
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37137207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41809777Medicaid
186198Medicare ID - Type Unspecified
CO41809777Medicaid