Provider Demographics
NPI:1275574758
Name:OGREN, JASON W (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:OGREN
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 1:1900 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5114
Mailing Address - Country:US
Mailing Address - Phone:970-350-2426
Mailing Address - Fax:970-350-2478
Practice Address - Street 1:1900 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5114
Practice Address - Country:US
Practice Address - Phone:970-350-2426
Practice Address - Fax:970-350-2478
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039933208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13486861Medicaid
COCO40977Medicare PIN
COG96496Medicare UPIN
COC449038Medicare PIN
COCO303607Medicare PIN