Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 33274 | CO |
NPI | 1003889353 |
---|---|
Provider Name | Dr. Mark Camden Loury |
First Address | Fort Collins, CO 80526-1872 |
Second Address | Fort Collins, CO 80526-1872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01332741 | (05) | CO |
040007458 | RAILROAD MEDICARE (01) | CO |
D72242 | (02) | CO |