Basic Information
| Provider Information | |||||||||
| NPI: | 1164089595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLETCHER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 150 | ||||||||
| Address2: | |||||||||
| City: | HYGIENE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038876753 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1610 DRY CREEK DRIVE | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037721600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | DR0014961 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | DR0014961 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.