Provider Demographics
NPI:1356300370
Name:CZECH, JEANINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:MARIE
Last Name:CZECH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:ATTN: 21 AMDS/SGPF - FLIGHT MEDICINE
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1541
Mailing Address - Country:US
Mailing Address - Phone:719-556-5585
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:ATTN: 21 AMDS/SGPF - FLIGHT MEDICINE
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-556-5585
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN28915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine