Provider Demographics
NPI:1194722538
Name:FORWARD, DOUGLAS PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:FORWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:PAUL
Other - Last Name:FORWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:719-538-2990
Practice Address - Street 1:350 INDIANA ST STE 250
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5074
Practice Address - Country:US
Practice Address - Phone:720-898-9427
Practice Address - Fax:303-302-0808
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01339720Medicaid
COG97450Medicare UPIN
CO01339720Medicaid