Provider Demographics
NPI:1124107909
Name:KESTEN, JEFFREY (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:KESTEN
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 1:755 HERITAGE RD
Mailing Address - Street 2:#100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3600
Mailing Address - Country:US
Mailing Address - Phone:303-277-0700
Mailing Address - Fax:303-277-0714
Practice Address - Street 1:755 HERITAGE RD
Practice Address - Street 2:#100
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3600
Practice Address - Country:US
Practice Address - Phone:303-277-0700
Practice Address - Fax:303-277-0714
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31919208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01319193Medicaid
CO381918Medicare ID - Type Unspecified
CO01319193Medicaid