Provider Demographics
NPI:1588821060
Name:JARECKE, JEREMY EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:EDWARD
Last Name:JARECKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9320 GRAND CORDERA PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924
Mailing Address - Country:US
Mailing Address - Phone:719-282-6337
Mailing Address - Fax:719-282-0532
Practice Address - Street 1:9320 GRAND CORDERA PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-282-6337
Practice Address - Fax:719-282-0532
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051117208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics