Provider Demographics
NPI:1578903571
Name:HUNT, JAN (MD)
Entity Type:Individual
Prefix:MISS
First Name:JAN
Middle Name:
Last Name:HUNT
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:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7417
Mailing Address - Fax:719-542-0809
Practice Address - Street 1:1600 N. GRAND AVE
Practice Address - Street 2:STE 400
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2760
Practice Address - Country:US
Practice Address - Phone:719-585-2500
Practice Address - Fax:719-543-1041
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103069207V00000X
CODR.0058565207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149350Medicaid