MEDICARE: DR. JENNIFER LEACH GAUDIANI 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	207R00000X	Internal Medicine Physician	45795	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45795	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1831172063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LEACH GAUDIANI MD

Provider Business Mailing Address
First Line	:	4700 HALE PKWY
Second Line	:	SUITE 380
City	:	DENVER
State	:	CO
Zip	:	80220-4045
Country	:	US
Telephone Number	:	720-515-2140
Fax Number	:	720-408-2541

Provider Business Practice Location Address
First Line	:	4700 HALE PKWY
Second Line	:	SUITE 380
City	:	DENVER
State	:	CO
Zip	:	80220-4045
Country	:	US
Telephone Number	:	720-515-2140
Fax Number	:	720-408-2541

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	09/06/2016

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