Individual
DR. JOHN BRADFORD KETTELLE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
SAVAHCS, 3601 S. 6TH AVE., TUCSON, AZ 85723-0001
(520) 792-1450
(520) 629-4603
Mailing address
SAVAHCS, 3601 S. 6TH AVE., TUCSON, AZ 85723-0001
(520) 792-1450
(520) 629-4603
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36533
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36533
ARIZONA MEDICAL LICENSE
AZ
01
—
A67553
LICENSE
CA
Enumeration date
07/17/2006
Last updated
10/21/2015
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