Provider Demographics
NPI:1265690374
Name:MOSS, JENNIFER LYNNE GOLDMAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE GOLDMAN
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:STE. D-100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-1120
Practice Address - Street 1:4500 E 9TH AVE STE 560S
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3934
Practice Address - Country:US
Practice Address - Phone:303-388-6874
Practice Address - Fax:303-322-0945
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46662207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85626341Medicaid
COP00711916OtherRAILROAD MEDICARE
COCO301319Medicare PIN