Provider Demographics
NPI:1962436055
Name:JENNINGS, JAMES EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EUGENE
Last Name:JENNINGS
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 1:5406 CANNON MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2704
Mailing Address - Country:US
Mailing Address - Phone:303-812-2288
Mailing Address - Fax:
Practice Address - Street 1:1181 WYNDEMERE CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2321
Practice Address - Country:US
Practice Address - Phone:303-651-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40425174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81105819Medicaid
CO81105819Medicaid