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Organization

GRAND JUNCTION GASTROENTEROLOGY, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TARA JACOBSON (PRACTICE ADMINISTRATOR)
(970) 257-6902
Entity
Organization

Contact information

Practice address
1035 WELLINGTON AVE, GRAND JUNCTION, CO 81501-8122
(970) 242-6600
(970) 241-8443
Mailing address
1035 WELLINGTON AVE, GRAND JUNCTION, CO 81501-8122
(970) 242-6600
(970) 242-1070

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01303684
CO
05
01342740
CO
05
35129549
CO
05
68804059
CO
05
93503300
CO
01
CK9301
RRPTAN
CO
01
P00001798
RRPTAN
CO
01
P00001800
RRPTAN
CO
01
P00403557
RRPTAN
CO
01
P00658273
RRPTAN
CO
Enumeration date
06/04/2006
Last updated
09/16/2022
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