# JAYDEEP MEDICAL PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891071627
- **Authorized official:** LORI LABRECQUE (ACCTS. MGR)
- **Authorized official phone:** (702) 453-3799

## Contact information

- **Practice address:** 2400 EDISON ST, BRUSH, CO 80723-1640
- **Practice address phone:** (970) 842-6200
- **Mailing address:** PO BOX 1115, FORT MORGAN, CO 80701-1115
- **Mailing address phone:** (702) 453-3799
- **Mailing address fax:** (702) 453-5741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208M00000X | Hospitalist Physician | 47973 | CO | Yes |

## Other

- **Enumeration date:** 10/25/2011
- **Last updated:** 10/25/2011