MEDICARE: PREMOD JAMES JOHN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	55747	CO
2	207Q00000X	Family Medicine Physician	T5751	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	446506YLTT	OTHER	CO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184982621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMOD JAMES JOHN M.D.

Provider Business Mailing Address
First Line	:	9135 S RIDGELINE BLVD
Second Line	:	STE 190
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2395
Country	:	US
Telephone Number	:	303-649-3140
Fax Number	:	303-649-3154

Provider Business Practice Location Address
First Line	:	9135 S RIDGELINE BLVD
Second Line	:	STE 190
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2395
Country	:	US
Telephone Number	:	303-649-3140
Fax Number	:	303-649-3154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	04/24/2024

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Directions to “ PREMOD JAMES JOHN M.D.” Practice Location

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