Provider Demographics
NPI:1922264175
Name:GLOWNEY, JASON WELLS (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WELLS
Last Name:GLOWNEY
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 1:4745 ARAPAHOE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1292
Mailing Address - Country:US
Mailing Address - Phone:720-550-6175
Mailing Address - Fax:
Practice Address - Street 1:4745 ARAPAHOE AVE STE 300
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1292
Practice Address - Country:US
Practice Address - Phone:720-550-6175
Practice Address - Fax:720-708-5058
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116605207Q00000X, 207R00000X
CO47816207R00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116605-1Medicaid
CO47929332Medicaid
IL200918008Medicare PIN
CO47929332Medicaid