Basic Information
| Provider Information | |||||||||
| NPI: | 1881983807 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KUETHE | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | WALKER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 E HARMONY RD UNIT 330 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702215878 | ||||||||
| FaxNumber: | 9702213564 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 E HARMONY RD UNIT 330 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702215878 | ||||||||
| FaxNumber: | 9702213564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2011 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35125553 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | DR.0065463 | CO | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.