=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043337199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JADE E. DILLON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 12/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11550 SHERIDAN BLVD SUITE 104
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80020-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-227-0562
-----------------------------------------------------
Fax | 720-306-3046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11550 SHERIDAN BLVD SUITE 104
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80020-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-227-0562
-----------------------------------------------------
Fax | 720-306-3046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0500X
-----------------------------------------------------
Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
-----------------------------------------------------
License Number | 34891
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 34891
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------