Provider Demographics
NPI:1831172063
Name:GAUDIANI, JENNIFER LEACH (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEACH
Last Name:GAUDIANI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4700 HALE PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4045
Mailing Address - Country:US
Mailing Address - Phone:720-515-2140
Mailing Address - Fax:720-408-2541
Practice Address - Street 1:4700 HALE PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4045
Practice Address - Country:US
Practice Address - Phone:720-515-2140
Practice Address - Fax:720-408-2541
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2016-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO45795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45795OtherSTATE LICENSE
CO45795OtherSTATE LICENSE
CT110009622Medicare ID - Type Unspecified