Provider Demographics
NPI:1710072905
Name:WESTON, JONATHAN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PETER
Last Name:WESTON
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 1:340 PRINTERS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3190
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7837
Practice Address - Street 1:2502 E PIKES PEAK AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6033
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-344-7840
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24119207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01241199Medicaid
COD24393Medicare UPIN
COC803536Medicare ID - Type Unspecified