Provider Demographics
NPI:1760412266
Name:GRIN, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:GRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 S POTOMAC ST STE 130
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4511
Mailing Address - Country:US
Mailing Address - Phone:303-337-3937
Mailing Address - Fax:303-337-2272
Practice Address - Street 1:1411 S POTOMAC ST
Practice Address - Street 2:SUITE #140
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4536
Practice Address - Country:US
Practice Address - Phone:303-337-3937
Practice Address - Fax:303-337-2272
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO39395207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18739822Medicaid
COC529808Medicare PIN