Individual
DR. RAJIV JETLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3235 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-1222
(928) 772-3340
(928) 759-9611
Mailing address
PO BOX 1629, SUITE A, PRESCOTT, AZ 86302-1629
(928) 772-3340
(928) 759-9611
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29064
AZ
207RI0200X
Infectious Disease Physician
29064
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
555724
—
AZ
01
—
AZ0887390
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
08/15/2005
Last updated
05/11/2017
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