Basic Information
| Provider Information | |||||||||
| NPI: | 1174697023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINTON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7950 KIPLING ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034246466 | ||||||||
| FaxNumber: | 3034208944 | ||||||||
| Practice Location | |||||||||
| Address1: | 4567 E 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033202121 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 06/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | CO 26157 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01261577 | 05 | CO | MEDICAID |