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NPI Code Detail

MEDICARE: DR. JASON ANDREW CANNELL DO

MEDICARE: DR. JASON ANDREW CANNELL DO
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
1207Q00000XFamily Medicine PhysicianDOS-1087HI
2207Q00000XFamily Medicine PhysicianDR.0050333CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841279940
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON ANDREW CANNELL DO
Provider Business Mailing Address
First Line : 5450 WESTERN AVE
Second Line :
City : BOULDER
State : CO
Zip : 80301-2709
Country : US
Telephone Number : 303-415-7450
Fax Number : 303-494-5265
Provider Business Practice Location Address
First Line : 1755 48TH ST
Second Line : SUITE 200
City : BOULDER
State : CO
Zip : 80301-2711
Country : US
Telephone Number : 303-415-7450
Fax Number : 303-494-5265
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 11/09/2017

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Directions to “ DR. JASON ANDREW CANNELL DO” Practice Location

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