Provider Demographics
NPI:1164446076
Name:LAW, JEREMY K (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:K
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 GRANT ST
Mailing Address - Street 2:#360
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:303-423-2000
Mailing Address - Fax:303-420-2520
Practice Address - Street 1:9351 GRANT ST
Practice Address - Street 2:SUITE 360
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-423-2000
Practice Address - Fax:303-420-2520
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO455988Medicare ID - Type Unspecified
COF55397Medicare UPIN
COCD2828Medicare PIN