Basic Information
| Provider Information | |||||||||
| NPI: | 1578525044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUTZY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1648 ELLIS ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597158811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065878631 | ||||||||
| FaxNumber: | 4065871343 | ||||||||
| Practice Location | |||||||||
| Address1: | 1648 ELLIS ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597158811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065878631 | ||||||||
| FaxNumber: | 4065871343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 5283 | MT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0144716 | 05 | MT | MEDICAID | 0061958 | 05 | MT | MEDICAID |