Provider Demographics
NPI:1417945759
Name:PACHECO, JOSE P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:P
Last Name:PACHECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-252-0104
Mailing Address - Fax:303-867-2776
Practice Address - Street 1:9141 GRANT ST STE 140
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4367
Practice Address - Country:US
Practice Address - Phone:303-252-0104
Practice Address - Fax:303-867-2776
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22013207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841198813OtherMOUNTAIN VIEW INTERPRETATION
CO01220136Medicaid
CO436375YPNQMedicare PIN
CO841198813OtherMOUNTAIN VIEW INTERPRETATION
COP01527840Medicare PIN
CO91054Medicare PIN