Basic Information
| Provider Information | |||||||||
| NPI: | 1659822500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAGE | ||||||||
| FirstName: | JEREMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 N HIGH ST STE 370 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038396001 | ||||||||
| FaxNumber: | 3038396033 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 N HIGH ST STE 370 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038396001 | ||||||||
| FaxNumber: | 3038396033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2016 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/04/2020 | ||||||||
| NPIReactivationDate: | 07/14/2020 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0006306 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.