1487648150 NPI number — DR. JAMIE DAHLGREN GLOVER M.D.

Table of content: DR. JAMIE DAHLGREN GLOVER M.D. (NPI 1487648150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487648150 NPI number — DR. JAMIE DAHLGREN GLOVER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLOVER
Provider First Name:
JAMIE
Provider Middle Name:
DAHLGREN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAHLGREN
Provider Other First Name:
JAMIE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487648150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17745 GRAMA RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80908-1360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-344-2789
Provider Business Mailing Address Fax Number:
719-362-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 DEER CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MONUMENT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80132-9089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-344-2789
Provider Business Practice Location Address Fax Number:
719-362-1102
Provider Enumeration Date:
09/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  DR51890 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)