Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | DR.0040963 | CO |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | DR.0040963 | CO |
N | 2081P2900X | Pain Medicine | 40963 | CO |
NPI | 1396716395 |
---|---|
Provider Name | Jason Michael Peragine |
First Address | Denver, CO 80217-5693 |
Second Address | Littleton, CO 80122-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86522 | (02) | FL |