Healthcare Provider Details

I. General information

NPI: 1659822500
Provider Name (Legal Business Name): JEREMY GAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date: 07/04/2020
Reactivation Date: 07/14/2020

III. Provider practice location address

2055 N HIGH ST STE 370
DENVER CO
80205-5545
US

IV. Provider business mailing address

2055 N HIGH ST STE 370
DENVER CO
80205-5545
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-6001
  • Fax: 303-839-6033
Mailing address:
  • Phone: 303-839-6001
  • Fax: 303-839-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006306
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: