Provider Demographics
NPI:1346246956
Name:KREGARMAN, JOHN JEROME (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEROME
Last Name:KREGARMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 S ONEIDA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1567
Mailing Address - Country:US
Mailing Address - Phone:303-393-1701
Mailing Address - Fax:503-210-7112
Practice Address - Street 1:9745 E HAMPDEN AVE
Practice Address - Street 2:STE 240
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4922
Practice Address - Country:US
Practice Address - Phone:303-752-7159
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO187103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07018708Medicaid
CO07018708Medicaid