Provider Demographics
NPI:1093868564
Name:JENNIFER D CECIL MD PLLC
Entity Type:Organization
Organization Name:JENNIFER D CECIL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-669-8998
Mailing Address - Street 1:2902 GINNALA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7817
Mailing Address - Country:US
Mailing Address - Phone:970-669-8998
Mailing Address - Fax:970-669-8693
Practice Address - Street 1:2902 GINNALA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7817
Practice Address - Country:US
Practice Address - Phone:970-669-8998
Practice Address - Fax:970-669-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK2709OtherMEDICARE RAILROAD
CO1201020001OtherPTAN
CO01326040Medicaid
COF33008Medicare UPIN
CO4253910001Medicare NSC
CO1201020001OtherPTAN