Provider Demographics
NPI:1205874732
Name:HARBERT, JENNIFER R (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:HARBERT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8719
Mailing Address - Country:US
Mailing Address - Phone:719-657-2510
Mailing Address - Fax:719-657-2511
Practice Address - Street 1:802 RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:CREEDE
Practice Address - State:CO
Practice Address - Zip Code:81130-5144
Practice Address - Country:US
Practice Address - Phone:719-658-0929
Practice Address - Fax:719-658-2830
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO37361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65936884Medicaid
COCL7818OtherMEDICARE
COL7818Medicare PIN