Provider Demographics
NPI:1881983807
Name:KUETHE, JOSHUA WALKER
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WALKER
Last Name:KUETHE
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 1:2121 E HARMONY RD UNIT 330
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3403
Mailing Address - Country:US
Mailing Address - Phone:970-221-5878
Mailing Address - Fax:970-221-3564
Practice Address - Street 1:2121 E HARMONY RD UNIT 330
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3403
Practice Address - Country:US
Practice Address - Phone:970-221-5878
Practice Address - Fax:970-221-3564
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35125553208600000X
390200000X
CODR.0065463208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program