Healthcare Provider Details

I. General information

NPI: 1881641298
Provider Name (Legal Business Name): ROY A JARED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 OGDEN ST STE 460
DENVER CO
80218-3666
US

IV. Provider business mailing address

1960 OGDEN ST STE 460
DENVER CO
80218-3666
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-2500
  • Fax: 303-318-2575
Mailing address:
  • Phone: 303-318-2500
  • Fax: 303-318-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23241
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number23241
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: