Provider Demographics
NPI:1578683223
Name:KEZEOR, JOSEPH J (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:KEZEOR
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 1:3205 N ACADEMY BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5152
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-266-8822
Practice Address - Fax:970-266-8833
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0053122207Q00000X
IAMD-45754207Q00000X
AZ57589207Q00000X
MEMD22717207Q00000X
MN64736207Q00000X
WAMD60913138207Q00000X
WI281-320207Q00000X
NV18414207Q00000X
UT11037807-1205207Q00000X
KS04-41643207Q00000X
SD11383207Q00000X
COCDRH.0053122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43600361Medicaid
NE47081633613Medicaid
COP01275583OtherMEDICARE RAILROAD
NE47081633613Medicaid