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NPI Code Detail

MEDICARE: SUPRIYA JAIN M.D.

MEDICARE: SUPRIYA JAIN 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
12085R0001XRadiation Oncology Physician036-150328IL

General Provider Information

NPI Number : 1639597529
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUPRIYA JAIN M.D.
Provider Business Mailing Address
First Line : 2000 BOISE AVE
Second Line :
City : LOVELAND
State : CO
Zip : 80538-5006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LADY MOON DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-4426
Country : US
Telephone Number : 970-810-3894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2014
Last Update Date : 07/08/2022

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