Provider Demographics
NPI:1144408154
Name:WEINER, JILL S (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:WEINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9397 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8576
Mailing Address - Country:US
Mailing Address - Phone:303-369-6977
Mailing Address - Fax:303-369-1909
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8575
Practice Address - Country:US
Practice Address - Phone:303-369-6977
Practice Address - Fax:303-369-1909
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO38062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58985581Medicaid
H07577Medicare UPIN
509888Medicare PIN