Provider Demographics
NPI:1669422382
Name:JAEGER, WARREN (MD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:JAEGER
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 1:550 HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9125
Mailing Address - Country:US
Mailing Address - Phone:719-488-9860
Mailing Address - Fax:719-488-9868
Practice Address - Street 1:550 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9125
Practice Address - Country:US
Practice Address - Phone:719-488-9860
Practice Address - Fax:719-488-9868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293810Medicaid
COG33991Medicare UPIN
CO01293810Medicaid