Provider Demographics
NPI:1639174261
Name:RICHKER, JEFF OWEN (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:OWEN
Last Name:RICHKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD
Mailing Address - Street 2:SUITE 6250
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:2600 CAMPUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3357
Practice Address - Country:US
Practice Address - Phone:303-665-1900
Practice Address - Fax:303-926-1781
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353705Medicaid
CO01353705Medicaid
COC808130Medicare PIN
COCOA103382Medicare PIN