Healthcare Provider Details

I. General information

NPI: 1306925482
Provider Name (Legal Business Name): JASON MICHAEL ROVAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E HAMPDEN AVE STE 500
ENGLEWOOD CO
80113-3781
US

IV. Provider business mailing address

601 E HAMPDEN AVE STE 500
ENGLEWOOD CO
80113-3781
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-7078
  • Fax: 303-744-0248
Mailing address:
  • Phone: 303-744-7078
  • Fax: 303-744-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0065253
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number46413
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: