# MR. JASON THOMAS WILLIAM TETZLAFF

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1043247091
- **Gender:** Man
- **Credential:** IDC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171000000X | Military Health Care Provider | 2099 | CA | — |
| 1710I1002X | Independent Duty Corpsman | 2099 | AZ | Yes |
| 174400000X | Specialist | — | CA | — |

## Other

- **Enumeration date:** 06/26/2006
- **Last updated:** 04/22/2008