MEDICARE: DR. JEFFREY WENTZ MD

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	2084P0800X	Psychiatry Physician	29778	NE
2	2084P0800X	Psychiatry Physician	DR.0065509	CO

General Provider Information

NPI Number	:	1487045803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY WENTZ MD

Provider Business Mailing Address
First Line	:	5350 TOMAH DR STE 3500
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6976
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-475-7171

Provider Business Practice Location Address
First Line	:	5350 TOMAH DR STE 3500
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6976
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-475-7171

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

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	05/08/2024

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