MEDICARE: JERALD WALTER KOEPKE MD

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	207K00000X	Allergy & Immunology Physician	DR.0020778	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1477524957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALD WALTER KOEPKE MD

Provider Business Mailing Address
First Line	:	125 RAMPART WAY STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80230-6429
Country	:	US
Telephone Number	:	720-858-7550
Fax Number	:	720-858-7615

Provider Business Practice Location Address
First Line	:	9331 S COLORADO BLVD STE 100
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7465
Country	:	US
Telephone Number	:	303-795-8177
Fax Number	:	303-797-2166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	04/29/2021

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