Provider Demographics
NPI:1003088840
Name:CONNERY, JENNY MILD (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MILD
Last Name:CONNERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FOUNDERS PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1476
Mailing Address - Country:US
Mailing Address - Phone:970-920-0104
Mailing Address - Fax:970-920-0124
Practice Address - Street 1:101 FOUNDERS PL
Practice Address - Street 2:SUITE 109
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1476
Practice Address - Country:US
Practice Address - Phone:970-920-0104
Practice Address - Fax:970-920-0124
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO48269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program