Provider Demographics
NPI:1912014879
Name:STROH, JENNIFER JEAN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:STROH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2139 N 12TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2901
Mailing Address - Country:US
Mailing Address - Phone:970-256-1664
Mailing Address - Fax:970-256-1707
Practice Address - Street 1:2139 N 12TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2901
Practice Address - Country:US
Practice Address - Phone:970-256-1664
Practice Address - Fax:970-256-1707
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO41942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53307577Medicaid
CO53307577Medicaid
COC810924Medicare PIN