Provider Demographics
NPI:1427065549
Name:JELDEN, DENNIS J (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:JELDEN
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 1:1001 E. JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-1854
Mailing Address - Country:US
Mailing Address - Phone:970-854-2500
Mailing Address - Fax:970-854-3440
Practice Address - Street 1:1001 E. JOHNSTON STREET
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-1854
Practice Address - Country:US
Practice Address - Phone:970-854-2500
Practice Address - Fax:970-854-3440
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO846014138007OtherROCKY MTN HMO
CO01349729Medicaid
CO080121472OtherRR MEDICARE PROV #
CO84601413802OtherPACIFICARE PROV #
NE84601413812Medicaid
COFA231008OtherBCBS PROV #
CO00017329OtherBANNERHEALTH PROV #
COFA231008OtherBCBS PROV #
CO080121472OtherRR MEDICARE PROV #