Provider Demographics
NPI:1396831517
Name:HARAZIN, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HARAZIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 TENDERFOOT HILL RD STE 350
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4003
Mailing Address - Country:US
Mailing Address - Phone:719-576-3800
Mailing Address - Fax:719-576-3828
Practice Address - Street 1:830 TENDERFOOT HILL RD STE 350
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4003
Practice Address - Country:US
Practice Address - Phone:719-576-3800
Practice Address - Fax:719-576-3828
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO368052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97682Medicare UPIN
C800794Medicare ID - Type Unspecified