Provider Demographics
NPI:1518161959
Name:WESTCOT, JONATHAN ERIC (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ERIC
Last Name:WESTCOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 GATEHOUSE CIR N
Mailing Address - Street 2:#204
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 W COSTILLA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3813
Practice Address - Country:US
Practice Address - Phone:719-471-2514
Practice Address - Fax:719-227-2119
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO375772084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO459324Medicaid
COC803960Medicare ID - Type Unspecified
CO459324Medicaid