Provider Demographics
NPI:1154451383
Name:HARRISON, JUDE B (MD)
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:B
Last Name:HARRISON
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 1:115 CONEJO PL
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5846
Mailing Address - Country:US
Mailing Address - Phone:970-247-3229
Mailing Address - Fax:970-259-6605
Practice Address - Street 1:115 CONEJO PL
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5846
Practice Address - Country:US
Practice Address - Phone:970-247-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD24708Medicare UPIN
COCP8438Medicare ID - Type Unspecified
COD24708Medicare UPIN