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NPI Code Detail

MEDICARE: JEFFREY MADISON DOUGLASS ANP-BC

MEDICARE: JEFFREY MADISON DOUGLASS ANP-BC
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
1363LA2200XAdult Health Nurse PractitionerCNP01482NM
2363LA2200XAdult Health Nurse PractitionerR67367NM
3363LA2200XAdult Health Nurse Practitioner304819NY
4363LA2200XAdult Health Nurse PractitionerC-APN.0000199-C-NPCO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366604506
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY MADISON DOUGLASS ANP-BC
Provider Business Mailing Address
First Line : 9766 KEENAN ST
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80130-8036
Country : US
Telephone Number : 646-318-6785
Fax Number :
Provider Business Practice Location Address
First Line : 2111 CHAMPA ST
Second Line :
City : DENVER
State : CO
Zip : 80205-2529
Country : US
Telephone Number : 303-312-2217
Fax Number : 303-293-2309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2008
Last Update Date : 06/24/2020

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