Healthcare Provider Details

I. General information

NPI: 1548495518
Provider Name (Legal Business Name): JAMIE L KOETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HWY 91 SOUTH
DILLON MT
59725
US

IV. Provider business mailing address

11730 JOYAS CT
SAN DIEGO CA
92124-2817
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-3000
  • Fax:
Mailing address:
  • Phone: 406-696-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMED-PHYS-LIC-19306
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: