Healthcare Provider Details

I. General information

NPI: 1750382149
Provider Name (Legal Business Name): JENNIFER M SANDERFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BRUCE MD

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 6TH STREET SUITE 202
CRESTED BUTTE CA
81224
US

IV. Provider business mailing address

PO BOX 167
CRESTED BUTTE CO
81224-0167
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-3333
  • Fax: 844-278-8636
Mailing address:
  • Phone: 970-349-3333
  • Fax: 844-278-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38507
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: