Individual
AMAR CHAND JETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 CARSON AVE, LA JUNTA, CO 81050-2751
(719) 383-5189
(719) 383-6566
Mailing address
1100 CARSON AVE, LA JUNTA, CO 81050-2751
(719) 383-5189
(719) 383-6566
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DR45869
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13352857
—
CO
01
—
DR-45869
STATE LICENSE
CO
01
—
P00452978
RAILROAD MEDICARE
CO
Enumeration date
10/04/2007
Last updated
04/18/2008
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