Provider Demographics
NPI:1245349620
Name:BENNETT, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BENNETT
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7300
Mailing Address - Fax:720-848-5079
Practice Address - Street 1:12700 E 19TH AVE
Practice Address - Street 2:PO BOX B182
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2560
Practice Address - Country:US
Practice Address - Phone:303-724-6450
Practice Address - Fax:303-724-4329
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO336542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01336544Medicaid
CO01336544Medicaid
COF72445Medicare PIN