Organization
JED J TATSUYAMA, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JED J TATSUYAMA MD (PRESIDENT)
(719) 543-1130
Entity
Organization
Contact information
Practice address
1619 N GREENWOOD ST, SUITE 200, PUEBLO, CO 81003-2644
(719) 543-1130
Mailing address
1619 N GREENWOOD ST, SUITE 200, PUEBLO, CO 81003-2644
(719) 543-1130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59825731
—
CO
Enumeration date
02/27/2008
Last updated
06/22/2008
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