Provider Demographics
NPI:1073667135
Name:JONES, JANELLE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:DENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:DENISE
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2610 TENDERFOOT HILL STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-1604
Mailing Address - Country:US
Mailing Address - Phone:719-538-5718
Mailing Address - Fax:719-226-8669
Practice Address - Street 1:2610 TENDERFOOT HILL STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-1604
Practice Address - Country:US
Practice Address - Phone:719-538-5718
Practice Address - Fax:719-226-8669
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41831713Medicaid
COCOAAA0452Medicare PIN