Provider Demographics
NPI:1174509186
Name:JETT, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:JETT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 JACKSON ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2761
Mailing Address - Country:US
Mailing Address - Phone:303-388-4461
Mailing Address - Fax:303-270-2206
Practice Address - Street 1:1400 JACKSON ST
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2761
Practice Address - Country:US
Practice Address - Phone:303-388-4461
Practice Address - Fax:303-270-2174
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-02-28
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Provider Licenses
StateLicense IDTaxonomies
MN21909207RP1001X
CO49412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN290002094OtherRAILROAD MEDICARE
CO66100283Medicaid
CO66100283Medicaid
COCOA103842Medicare PIN