Healthcare Provider Details

I. General information

NPI: 1710072905
Provider Name (Legal Business Name): JONATHAN PETER WESTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E PIKES PEAK AVE 3RD FLOOR
COLORADO SPRINGS CO
80909-6033
US

IV. Provider business mailing address

340 PRINTERS PKWY
COLORADO SPRINGS CO
80910-3190
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-344-7840
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number24119
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: