Provider Demographics
NPI:1871348649
Name:JAECKEL, SOPHIA JULIA (DO)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:JULIA
Last Name:JAECKEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3187
Mailing Address - Country:US
Mailing Address - Phone:720-243-2598
Mailing Address - Fax:
Practice Address - Street 1:2698 PATTERSON RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8211
Practice Address - Country:US
Practice Address - Phone:970-298-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0010212207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine