Provider Demographics
NPI:1386672921
Name:REED, JENNIFER BLUMOFF (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BLUMOFF
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:BLUMOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:106 CLEAR CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-382-9228
Mailing Address - Fax:
Practice Address - Street 1:106 CLEAR CREEK LOOP
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-382-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO437032085R0202X
TXK52582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157873402Medicaid
TX157873404Medicaid
TX157873402Medicaid
TX157873404Medicaid
TX8A6938Medicare PIN
TXP00027868Medicare PIN
TXH81725Medicare UPIN
TXP00034794Medicare PIN