Healthcare Provider Details

I. General information

NPI: 1134568652
Provider Name (Legal Business Name): JILL SPICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JILL SPERLAZZA

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W OXFORD AVE
DENVER CO
80236-3108
US

IV. Provider business mailing address

3520 W OXFORD AVE
DENVER CO
80236-3108
US

V. Phone/Fax

Practice location:
  • Phone: 303-866-7066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberDR0058287
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR74131
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: