Provider Demographics
NPI:1154319168
Name:ASCHENBRENER, PAMELA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:ASCHENBRENER
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 1:704 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:WESTCLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:81252-8588
Mailing Address - Country:US
Mailing Address - Phone:719-783-2380
Mailing Address - Fax:
Practice Address - Street 1:704 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-8588
Practice Address - Country:US
Practice Address - Phone:719-783-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01284769Medicaid
CO801256Medicare ID - Type Unspecified
CO01284769Medicaid