Individual
JACK GERVAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 PEAK ONE DR., FRISCO, CO 80443-0738
(970) 668-8123
(970) 668-2844
Mailing address
PO BOX 5788, DENVER, CO 80217-5788
(303) 202-1280
(303) 202-1281
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
50036
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20326023101
PACIFICARE SECURE HORIZONS
—
05
—
73872369
—
CO
05
—
816363
—
AZ
01
—
P00980274
RR MEDICARE
—
Enumeration date
06/06/2008
Last updated
08/14/2013
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