Healthcare Provider Details

I. General information

NPI: 1750602660
Provider Name (Legal Business Name): JARED R SEIBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BUCK CREEK RD STE 200
AVON CO
81620-5428
US

IV. Provider business mailing address

PO BOX 4330
AVON CO
81620-4330
US

V. Phone/Fax

Practice location:
  • Phone: 709-266-3409
  • Fax: 970-926-6348
Mailing address:
  • Phone: 970-926-6340
  • Fax: 970-926-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD-16524
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0069061
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: