Provider Demographics
NPI:1396872347
Name:KAPLAN, JEREMIAH I (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:I
Last Name:KAPLAN
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 1:1985 BLUEBELL AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-8023
Mailing Address - Country:US
Mailing Address - Phone:303-499-1720
Mailing Address - Fax:
Practice Address - Street 1:1985 BLUEBELL AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-8023
Practice Address - Country:US
Practice Address - Phone:303-440-8688
Practice Address - Fax:303-557-6163
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38583207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04334361Medicaid
CO4334661Medicaid
CO04334361Medicaid
COCOB4240Medicare PIN
CO4334661Medicaid