Provider Demographics
NPI:1427089408
Name:JOHAR, JASJOT SINGH
Entity type:Individual
Prefix:
First Name:JASJOT
Middle Name:SINGH
Last Name:JOHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASJOT
Other - Middle Name:S
Other - Last Name:JOHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 173817
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-8643
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:2000 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5006
Practice Address - Country:US
Practice Address - Phone:970-635-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36707207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01367077Medicaid
WY113819700Medicaid
930061546OtherRAILROAD MEDICARE
COCO307123Medicare PIN
COCS5138Medicare PIN
930061546OtherRAILROAD MEDICARE