Provider Demographics
NPI:1083648679
Name:GUERRASIO, JEANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:GUERRASIO
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12401 E 17TH AVE
Practice Address - Street 2:MAIL CODE F782
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2548
Practice Address - Country:US
Practice Address - Phone:720-848-4289
Practice Address - Fax:720-848-4293
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44330207R00000X, 208M00000X
CODR.0044330208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04634772Medicaid
CO805807Medicare PIN