Organization
WESTERN INFECTIOUS DISEASE INFUSION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY A. DESJARDIN M.D. (PHYSICIAN/PRESIDENT)
(303) 425-9245
Entity
Organization
Contact information
Practice address
3303 W 144TH AVE, SUITE 103, BROOMFIELD, CO 80023-9464
(303) 425-9245
(303) 425-1378
Mailing address
PO BOX 1449, WHEAT RIDGE, CO 80034-1449
(303) 425-9245
(303) 425-1378
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C377608
MEDICARE GROUP NUMBER
—
Enumeration date
09/19/2014
Last updated
09/19/2014
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