Individual
PREMOD JAMES JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9135 S RIDGELINE BLVD, STE 190, HIGHLANDS RANCH, CO 80129-2395
(303) 649-3140
(303) 649-3154
Mailing address
9135 S RIDGELINE BLVD, STE 190, HIGHLANDS RANCH, CO 80129-2395
(303) 649-3140
(303) 649-3154
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
55747
CO
207Q00000X
Family Medicine Physician
Primary
T5751
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
446506YLTT
MEDICARE PTAN
CO
05
—
77780094
—
CO
Enumeration date
05/02/2012
Last updated
04/24/2024
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