Provider Demographics
NPI:1437138179
Name:CECIL, JENNIFER DIANE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:CECIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 GINNALA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7817
Mailing Address - Country:US
Mailing Address - Phone:970-669-8998
Mailing Address - Fax:970-669-8693
Practice Address - Street 1:2902 GINNALA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7817
Practice Address - Country:US
Practice Address - Phone:970-669-8998
Practice Address - Fax:970-669-8693
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK2709OtherMEDICARE RAILROAD
CO01326040Medicaid
COCK2709OtherMEDICARE RAILROAD
COF33008Medicare UPIN