Provider Demographics
NPI:1295779510
Name:WESTERN SLOPE ONCOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:WESTERN SLOPE ONCOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-384-2274
Mailing Address - Street 1:PO BOX 3110
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-3110
Mailing Address - Country:US
Mailing Address - Phone:970-384-2274
Mailing Address - Fax:970-384-2276
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-384-2274
Practice Address - Fax:970-384-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34798207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89678567Medicaid
COC45761Medicare PIN
CO89678567Medicaid