Organization
JETTISON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT AYALA (PRESIDENT)
(212) 321-0477
Entity
Organization
Contact information
Practice address
600 17TH STREET, DENVER, CO 80202-5428
(303) 260-6400
Mailing address
45 PORTLAND RD STE 7-226, KENNEBUNK, ME 04043-6660
(207) 292-6261
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/30/2021
Last updated
12/30/2021
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