Provider Demographics
NPI:1073827820
Name:KRAUSE, JACOB (PA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 DELAWARE ST
Mailing Address - Street 2:2ND FLOOR, NORTH TOWER
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4532
Mailing Address - Country:US
Mailing Address - Phone:303-602-7600
Mailing Address - Fax:
Practice Address - Street 1:700 DELAWARE ST
Practice Address - Street 2:2ND FLOOR, NORTH TOWER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4532
Practice Address - Country:US
Practice Address - Phone:303-602-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06868363AS0400X
390200000X
CO0003542363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX827N58OtherBCBS
TX216997101Medicaid
TX827N58OtherBCBS
TXP00875508Medicare PIN