Healthcare Provider Details

I. General information

NPI: 1659901007
Provider Name (Legal Business Name): JEANETTE KATHARINE KLAMFOTH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE KLAMFOTH ROSEVEAR D.O.

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

IV. Provider business mailing address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2778
  • Fax:
Mailing address:
  • Phone: 907-580-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.015375
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10086028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: