Healthcare Provider Details

I. General information

NPI: 1053846543
Provider Name (Legal Business Name): JEFFREY DALTON HASSEBROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFF HASSEBROCK M.D.

II. Dates (important events)

Enumeration Date: 04/22/2017
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 AURORA CT
AURORA CO
80045-2541
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number57005
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberDR.0068695
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: