Provider Demographics
NPI:1598828949
Name:WESTERN INFECTIOUS DISEASE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:WESTERN INFECTIOUS DISEASE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DESJARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-425-9245
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-1449
Mailing Address - Country:US
Mailing Address - Phone:303-425-9245
Mailing Address - Fax:303-425-1378
Practice Address - Street 1:3885 UPHAM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4880
Practice Address - Country:US
Practice Address - Phone:303-425-9245
Practice Address - Fax:303-425-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007191Medicaid
COC97408Medicare PIN