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General NPI Number Information
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NPI Number | 1124559398
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES JAEGER
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Gender | Male
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 80 HEALTH PARK DR STE 100
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City | LOUISVILLE
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State | CO
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Zip | 80027-4644
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Country | US
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Telephone | 303-666-2720
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Fax | 303-666-2734
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Provider Business Mailing Address
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Address Line | 2750 BROADWAY ST
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City | BOULDER
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State | CO
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Zip | 80304-3586
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Country | US
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Telephone | 304-440-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | DR.0064694
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License Number State | CO
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