Provider Demographics
NPI:1376589242
Name:FLAXENBURG, JESSE ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ALEXANDER
Last Name:FLAXENBURG
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 1:1914 LELARAY ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2800
Mailing Address - Country:US
Mailing Address - Phone:719-632-7641
Mailing Address - Fax:719-632-2925
Practice Address - Street 1:1914 LELARAY ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2800
Practice Address - Country:US
Practice Address - Phone:719-632-7641
Practice Address - Fax:719-632-2925
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44572207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00377881Medicaid
805631Medicare ID - Type Unspecified
I09132Medicare UPIN