Provider Demographics
NPI:1326075003
Name:COLONNELLO, JAMIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:S
Last Name:COLONNELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2008 CARIBOU DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4325
Mailing Address - Country:US
Mailing Address - Phone:970-484-4757
Mailing Address - Fax:970-484-4759
Practice Address - Street 1:2008 CARIBOU DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4325
Practice Address - Country:US
Practice Address - Phone:970-484-4757
Practice Address - Fax:970-484-4759
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20020026342085R0202X
CODR.00557092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology