Provider Demographics
NPI:1215933866
Name:PERRINJAQUET, CRAIG L (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:PERRINJAQUET
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:P.O. BOX 911416
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1416
Mailing Address - Country:US
Mailing Address - Phone:970-547-9200
Mailing Address - Fax:970-262-2196
Practice Address - Street 1:400 N PARK AVE
Practice Address - Street 2:STE 1-A
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8850
Practice Address - Country:US
Practice Address - Phone:970-547-9200
Practice Address - Fax:970-262-2196
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269315Medicaid
G6258Medicare ID - Type Unspecified
CO01269315Medicaid