Individual
MR. FREDERICK JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
525 N FOOTE AVE, STE 302, COLORADO SPRINGS, CO 80909-4501
(719) 365-5445
(719) 365-5530
Mailing address
2695 ROCKY MOUNTAIN AVE, SUITE 150, LOVELAND, CO 80538-8702
(970) 624-4443
(970) 490-4175
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1908
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86376365
—
CO
Enumeration date
05/22/2007
Last updated
02/16/2015
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