Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | DR0014961 | CO |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | DR0014961 | CO |
NPI | 1164089595 |
---|---|
Provider Name | Mr. John O Cletcher JR. |
First Address | Hygiene, CO 80533 |
Second Address | Longmont, CO 80503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |