Provider Demographics
NPI:1164089595
Name:CLETCHER, JOHN O JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:O
Last Name:CLETCHER
Suffix:JR
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:P.O. BOX 150
Mailing Address - Street 2:
Mailing Address - City:HYGIENE
Mailing Address - State:CO
Mailing Address - Zip Code:80533
Mailing Address - Country:US
Mailing Address - Phone:303-887-6753
Mailing Address - Fax:
Practice Address - Street 1:1610 DRY CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503
Practice Address - Country:US
Practice Address - Phone:303-772-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0014961207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery