Provider Demographics
NPI:1407160476
Name:LOFLEY, KENT JEREL (DO)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:JEREL
Last Name:LOFLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8719
Mailing Address - Country:US
Mailing Address - Phone:719-657-2510
Mailing Address - Fax:719-657-4106
Practice Address - Street 1:310 COUNTY ROAD 14
Practice Address - Street 2:
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-8719
Practice Address - Country:US
Practice Address - Phone:719-657-2510
Practice Address - Fax:719-657-4106
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1140207Q00000X
UT10828844-1204207Q00000X
WY11744C207Q00000X
MN64515207Q00000X
AZ007796207Q00000X
IL036147333207Q00000X
NVCL0031207Q00000X
WAOP60896839207Q00000X
CA20A16859207Q00000X
IADO-05339207Q00000X
SD11384207Q00000X
CODR.0050812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300942YLTTOtherMEDICARE PTAN
CO50812OtherCOLO LICENSE
CO87220059Medicaid