Healthcare Provider Details

I. General information

NPI: 1487648150
Provider Name (Legal Business Name): JAMIE DAHLGREN GLOVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNNE DAHLGREN

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 DEER CREEK RD SUITE 101
MONUMENT CO
80132-9089
US

IV. Provider business mailing address

17745 GRAMA RDG
COLORADO SPRINGS CO
80908-1360
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-2789
  • Fax: 719-362-1102
Mailing address:
  • Phone: 719-344-2789
  • Fax: 719-362-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR51890
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: