MEDICARE: JD GLOVER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	51890	CO

General Provider Information

NPI Number	:	1225575103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JD GLOVER, PLLC

Provider Business Mailing Address
First Line	:	17745 GRAMA RDG
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1360
Country	:	US
Telephone Number	:	850-797-3560
Fax Number	:	719-362-1102

Provider Business Practice Location Address
First Line	:	1840 DEER CREEK RD
Second Line	:	SUITE 101
City	:	MONUMENT
State	:	CO
Zip	:	80132-9089
Country	:	US
Telephone Number	:	719-344-2789
Fax Number	:	719-362-1102

Authorized Official
Title or Position	:	FOUNDER/SOLO PHYSICIAN
Name	:	DR. JAMIE DAHLGREN GLOVER
Credential	:	MD
Telephone Number	:	850-797-3560

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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