Provider Demographics
NPI:1366606956
Name:DOODY, JAMES B (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:DOODY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14090 W 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1779
Mailing Address - Country:US
Mailing Address - Phone:303-918-8866
Mailing Address - Fax:720-929-8444
Practice Address - Street 1:3260 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4406
Practice Address - Country:US
Practice Address - Phone:720-929-8300
Practice Address - Fax:720-929-8444
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1139363A00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99150735Medicaid
CO99150735Medicaid