Provider Demographics
NPI:1871606772
Name:ALLARD, JENNY D (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:D
Last Name:ALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:719-633-5515
Mailing Address - Fax:719-471-2258
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3113
Practice Address - Country:US
Practice Address - Phone:719-633-5515
Practice Address - Fax:719-471-2258
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41634560Medicaid
CO41634560Medicaid
COCO300188Medicare PIN
COC806225Medicare PIN