Provider Demographics
NPI:1326025222
Name:VALENTINE, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:VALENTINE
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 1:1551 LARIMER ST APT 904
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1629
Mailing Address - Country:US
Mailing Address - Phone:720-530-6757
Mailing Address - Fax:303-575-9484
Practice Address - Street 1:1551 LARIMER ST APT 904
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1629
Practice Address - Country:US
Practice Address - Phone:720-530-6757
Practice Address - Fax:303-575-9484
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21608207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY103524000Medicaid
CO01216084Medicaid
MT3506685Medicaid
NMW6944Medicaid
TX051294901Medicaid
KS100121220AMedicaid
NE84113438513Medicaid
TX051294901Medicaid
CO01216084Medicaid
COCV2268Medicare PIN