Provider Demographics
NPI:1801842646
Name:NASH, JERRY D (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:D
Last Name:NASH
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 1:2121 E HARMONY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3400
Mailing Address - Country:US
Mailing Address - Phone:970-226-6111
Mailing Address - Fax:970-226-6707
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-226-6111
Practice Address - Fax:970-226-6707
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO42523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE14868Medicare UPIN