Provider Demographics
NPI:1548341415
Name:BARTLEY, JEREMIAH AMON (MD)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:AMON
Last Name:BARTLEY
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 1:1360 S POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4505
Mailing Address - Country:US
Mailing Address - Phone:303-337-5575
Mailing Address - Fax:303-745-6264
Practice Address - Street 1:4100 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-1928
Practice Address - Country:US
Practice Address - Phone:303-433-2565
Practice Address - Fax:303-433-2567
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275023Medicaid
D24952Medicare UPIN
CO01275023Medicaid