Provider Demographics
NPI:1134316300
Name:KETTLER, JASON HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:HARRIS
Last Name:KETTLER
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 1:125 16TH AVE E
Mailing Address - Street 2:GROUP HEALTH COOPERATIVE - CENTRAL CAMPUS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5211
Mailing Address - Country:US
Mailing Address - Phone:206-326-3055
Mailing Address - Fax:206-326-2379
Practice Address - Street 1:125 16TH AVE E
Practice Address - Street 2:GROUP HEALTH COOPERATIVE - CENTRAL CAMPUS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5211
Practice Address - Country:US
Practice Address - Phone:206-326-3055
Practice Address - Fax:206-326-2379
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00047140207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease