Provider Demographics
NPI:1588980130
Name:RUMLEY, JACOB CARL LEWIS (DO)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:CARL LEWIS
Last Name:RUMLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JACOB
Other - Middle Name:CARL
Other - Last Name:RUMLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3351 MOURNING DOVE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5828
Mailing Address - Country:US
Mailing Address - Phone:970-217-6984
Mailing Address - Fax:
Practice Address - Street 1:9005 GRANT ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4300
Practice Address - Country:US
Practice Address - Phone:303-287-2800
Practice Address - Fax:303-287-7357
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75002207X00000X
CODR.0064096207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery