Individual
DR. JD WIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3519 RICHMOND DR, FORT COLLINS, CO 80526-5995
(970) 204-0300
(970) 221-5206
Mailing address
3702 AUTOMATION WAY, SUITE 103, FORT COLLINS, CO 80525-5737
(970) 224-1670
(970) 495-6218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47085
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61706078
—
CO
01
—
CO303242
MEDICARE ID
CO
Enumeration date
06/06/2007
Last updated
09/17/2014
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