Provider Demographics
NPI:1487648150
Name:GLOVER, JAMIE DAHLGREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:DAHLGREN
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:DAHLGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17745 GRAMA RDG
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1360
Mailing Address - Country:US
Mailing Address - Phone:719-344-2789
Mailing Address - Fax:719-362-1102
Practice Address - Street 1:1840 DEER CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9089
Practice Address - Country:US
Practice Address - Phone:719-344-2789
Practice Address - Fax:719-362-1102
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR51890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN