Provider Demographics
NPI:1588755458
Name:HOWARD, JACQUELINE DENISE (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DENISE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14022 E TUFTS DR APT 924
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5617
Mailing Address - Country:US
Mailing Address - Phone:720-808-3925
Mailing Address - Fax:
Practice Address - Street 1:2851 S PARKER RD STE 444
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2802
Practice Address - Country:US
Practice Address - Phone:720-255-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45198207QA0505X, 207RA0401X, 208D00000X, 261QP2300X
WAMD60648223208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072674Medicaid
1588755458OtherNPI