1841237070 NPI number — DR. JEANNAE MARIE DERGANCE MD

Table of content: ERIC PARNES PT (NPI 1851408280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841237070 NPI number — DR. JEANNAE MARIE DERGANCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DERGANCE
Provider First Name:
JEANNAE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COCHRAN
Provider Other First Name:
JEANNAE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841237070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12250 E ILIFF AVE
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-6318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-306-4321
Provider Business Mailing Address Fax Number:
720-524-1551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12250 E ILIFF AVE
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-6318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-306-4321
Provider Business Practice Location Address Fax Number:
720-524-1551
Provider Enumeration Date:
05/31/2006

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: 207QG0300X , with the licence number:  44518 , 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)

  • Identifier: 15634248 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com