| Jed J Tatsuyama, Md, Pc | |
|
1619 N Greenwood St Suite 200 Pueblo CO 81003-2644 | |
| (719) 543-1130 | |
| Not Available |
| Full Name | Jed J Tatsuyama, Md, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1619 N Greenwood St, Pueblo, Colorado |
| Authorized Official Name and Position | Jed J Tatsuyama (PRESIDENT) |
| Authorized Official Contact | 7195431130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jed J Tatsuyama, Md, Pc 1619 N Greenwood St Suite 200 Pueblo CO 81003-2644 Ph: (719) 543-1130 | Jed J Tatsuyama, Md, Pc 1619 N Greenwood St Suite 200 Pueblo CO 81003-2644 Ph: (719) 543-1130 |
| NPI Number | 1992974554 |
|---|---|
| Provider Enumeration Date | 02/27/2008 |
| Last Update Date | 06/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992974554 | NPI | - | NPPES |
| 59825731 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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