Provider Demographics
NPI:1386039444
Name:CLOUTIER, JON
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 E 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7966
Mailing Address - Country:US
Mailing Address - Phone:800-276-0274
Mailing Address - Fax:800-881-0266
Practice Address - Street 1:6124 E 162ND AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80602-7966
Practice Address - Country:US
Practice Address - Phone:800-276-0274
Practice Address - Fax:800-881-0266
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29777824332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies