Healthcare Provider Details

I. General information

NPI: 1851753602
Provider Name (Legal Business Name): JAREAU CORDELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 E ILIFF AVE STE 210
AURORA CO
80014-1425
US

IV. Provider business mailing address

14001 E ILIFF AVE STE 210
AURORA CO
80014-1425
US

V. Phone/Fax

Practice location:
  • Phone: 303-996-9601
  • Fax: 303-369-2605
Mailing address:
  • Phone: 303-996-9601
  • Fax: 303-369-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0062764
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: