Individual
DR. JED JITSUGO TATSUYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1619 N GREENWOOD ST, SUITE 200, PUEBLO, CO 81003-2644
(719) 543-1130
(719) 561-2764
Mailing address
1619 N GREENWOOD STREET, SUITE 200, PUEBLO, CO 81003
(719) 543-1130
(719) 561-2764
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41404
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62287338
—
CO
Enumeration date
06/14/2006
Last updated
04/30/2008
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