Provider Demographics
NPI:1437198942
Name:KIRK, JUDE JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:JAMES
Last Name:KIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 PECOS ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3888
Mailing Address - Country:US
Mailing Address - Phone:303-457-4497
Mailing Address - Fax:303-450-4692
Practice Address - Street 1:12201 PECOS ST
Practice Address - Street 2:UNIT 500
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3888
Practice Address - Country:US
Practice Address - Phone:303-457-4497
Practice Address - Fax:303-450-4692
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01278845Medicaid
010048030OtherRAILROAD MEDICARE
CO01278845Medicaid
65108Medicare ID - Type Unspecified
COC65108Medicare PIN