Basic Information
| Provider Information | |||||||||
| NPI: | 1629011200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 557 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802910557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674155 | ||||||||
| FaxNumber: | 3034674156 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 LUTHERAN PKWY | ||||||||
| Address2: | #G20 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034033670 | ||||||||
| FaxNumber: | 3034239293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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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 | 39925 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.