Organization
JAYDEEP MEDICAL PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCTS. MGR)
(702) 453-3799
Entity
Organization
Contact information
Practice address
2400 EDISON ST, BRUSH, CO 80723-1640
(970) 842-6200
Mailing address
PO BOX 1115, FORT MORGAN, CO 80701-1115
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
47973
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47973
CO LIC
CO
Enumeration date
10/25/2011
Last updated
10/25/2011
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