Basic Information
| Provider Information | |||||||||
| NPI: | 1427065549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JELDEN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 E. JOHNSON STREET | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807341854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708542500 | ||||||||
| FaxNumber: | 9708543440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 E. JOHNSTON STREET | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807341854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708542500 | ||||||||
| FaxNumber: | 9708543440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 05/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34972 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 846014138007 | 01 | CO | ROCKY MTN HMO | OTHER | 01349729 | 05 | CO | MEDICAID | 080121472 | 01 | CO | RR MEDICARE PROV # | OTHER | 84601413802 | 01 | CO | PACIFICARE PROV # | OTHER | 84601413812 | 05 | NE | MEDICAID | FA231008 | 01 | CO | BCBS PROV # | OTHER | 00017329 | 01 | CO | BANNERHEALTH PROV # | OTHER |