Healthcare Provider Details

I. General information

NPI: 1457615064
Provider Name (Legal Business Name): CHRISTOPHER SCOTT JETTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 E 42ND AVE
ANCHORAGE AK
99508-5202
US

IV. Provider business mailing address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 907-569-3668
  • Fax:
Mailing address:
  • Phone: 970-565-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD.0000936
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number110790
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: