Provider Demographics
NPI:1659360238
Name:ADLER, JAY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:ADLER
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 1:2220 WEST COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-473-6306
Mailing Address - Fax:719-473-0132
Practice Address - Street 1:2 S CASCADE AVE
Practice Address - Street 2:SUITE140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1624
Practice Address - Country:US
Practice Address - Phone:719-538-2950
Practice Address - Fax:719-538-2996
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01228188Medicaid
COD24161Medicare UPIN
CO01228188Medicaid