Provider Demographics
NPI:1023261534
Name:HESTER, JAN (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:HESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E ELIZABETH #G1
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4044
Mailing Address - Country:US
Mailing Address - Phone:970-493-2776
Mailing Address - Fax:970-493-2772
Practice Address - Street 1:1120 E ELIZABETH #G1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-493-2776
Practice Address - Fax:970-493-2772
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327543Medicaid
CO89650727Medicaid
COC534428Medicare PIN
CO01327543Medicaid