Provider Demographics
NPI:1063833051
Name:PLEASANT, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:PLEASANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 EGRET CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8681
Mailing Address - Country:US
Mailing Address - Phone:970-629-9523
Mailing Address - Fax:970-242-9629
Practice Address - Street 1:727 EGRET CIR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8681
Practice Address - Country:US
Practice Address - Phone:970-629-9523
Practice Address - Fax:970-242-9629
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00826332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies