Healthcare Provider Details

I. General information

NPI: 1184845539
Provider Name (Legal Business Name): JASON MARSHALL ALLEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

PO BOX 63300
COLORADO SPRINGS CO
80962-3300
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5853
  • Fax: 719-365-1048
Mailing address:
  • Phone: 719-578-1162
  • Fax: 719-578-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0054989
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14261150-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: