Provider Demographics
NPI:1205435021
Name:GREGORY, JASON TODD
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:TODD
Last Name:GREGORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S ACADEMY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-2473
Mailing Address - Country:US
Mailing Address - Phone:719-434-2402
Mailing Address - Fax:719-358-8169
Practice Address - Street 1:2130 S ACADEMY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2473
Practice Address - Country:US
Practice Address - Phone:719-434-2402
Practice Address - Fax:719-358-8169
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04N2FV253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care