Provider Demographics
NPI:1376557603
Name:KINZIE, JEANNIE JONES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:JONES
Last Name:KINZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 INTERLOCKEN DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8846
Mailing Address - Country:US
Mailing Address - Phone:303-670-0435
Mailing Address - Fax:303-670-4581
Practice Address - Street 1:3221 INTERLOCKEN DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8846
Practice Address - Country:US
Practice Address - Phone:303-670-0435
Practice Address - Fax:303-670-4581
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26665207UN0902X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01266659Medicaid
CO01266659Medicaid
COE06340Medicare UPIN