1982642997 NPI number — DR. JENNIFER A MCBRIDE MD

Table of content: DR. JENNIFER A MCBRIDE MD (NPI 1982642997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982642997 NPI number — DR. JENNIFER A MCBRIDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBRIDE
Provider First Name:
JENNIFER
Provider Middle Name:
A
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:
HUANG
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1982642997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7351 E LOWRY BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80230-6083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-532-8719
Provider Business Mailing Address Fax Number:
303-318-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8199 E 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80230-7163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-532-8719
Provider Business Practice Location Address Fax Number:
720-532-8719
Provider Enumeration Date:
06/02/2006

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: 207R00000X , with the licence number:  42373 , 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: C166251 . This is a "CALIFORNIA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 42373 . This is a "LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: P00274398 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09138064 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD60590016 . This is a "WASHINGTON MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: R1824 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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