Provider Demographics
NPI:1497757876
Name:JEWELL, GARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:JEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3910 S CAREFREE CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3010
Mailing Address - Country:US
Mailing Address - Phone:719-574-4780
Mailing Address - Fax:719-574-8405
Practice Address - Street 1:3910 S CAREFREE CIR
Practice Address - Street 2:SUITE C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3010
Practice Address - Country:US
Practice Address - Phone:719-574-4780
Practice Address - Fax:719-574-8405
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COCO33000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803129Medicare PIN
A73140Medicare UPIN