Provider Demographics
NPI:1023181807
Name:PULA, JENNIFER RUTH (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:PULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RUTH
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7821 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6109
Mailing Address - Country:US
Mailing Address - Phone:303-422-2343
Mailing Address - Fax:303-422-8291
Practice Address - Street 1:7821 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6109
Practice Address - Country:US
Practice Address - Phone:303-422-2343
Practice Address - Fax:303-422-8291
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803222Medicare PIN
COI41613Medicare UPIN