Healthcare Provider Details

I. General information

NPI: 1831178763
Provider Name (Legal Business Name): JEAN KARYL TING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE CREST ST
RANGELY CO
81648-3105
US

IV. Provider business mailing address

225 EAGLE CREST ST
RANGELY CO
81648-3105
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-1686
  • Fax: 970-254-1687
Mailing address:
  • Phone: 970-254-1686
  • Fax: 970-254-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22565
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: