Healthcare Provider Details

I. General information

NPI: 1518582048
Provider Name (Legal Business Name): JAKE FOOTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 PEARL PKWY STE 200
BOULDER CO
80301-3080
US

IV. Provider business mailing address

4740 PEARL PKWY STE 200
BOULDER CO
80301-3080
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-2730
  • Fax: 303-449-5821
Mailing address:
  • Phone: 303-449-2730
  • Fax: 303-449-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA12633000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberDR.0077480
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0077480
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: