Provider Demographics
NPI:1912022005
Name:UPDIKE, JAN C (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:UPDIKE
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 1:7401 CHURCH RANCH BLVD
Mailing Address - Street 2:S-202
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5539
Mailing Address - Country:US
Mailing Address - Phone:303-282-4015
Mailing Address - Fax:720-225-0918
Practice Address - Street 1:420 S MARION PKWY
Practice Address - Street 2:U-501
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2542
Practice Address - Country:US
Practice Address - Phone:303-918-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163072083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305867Medicare UPIN
COCOB4545Medicare PIN