Provider Demographics
NPI:1902082860
Name:WHETSTINE, JIM GRANT
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:GRANT
Last Name:WHETSTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6648 FOUNTAIN RIDGE CIR.
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4712
Mailing Address - Country:US
Mailing Address - Phone:719-648-1405
Mailing Address - Fax:719-382-8411
Practice Address - Street 1:6648 FOUNTAIN RIDGE CIR.
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4712
Practice Address - Country:US
Practice Address - Phone:719-648-1405
Practice Address - Fax:719-382-8411
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications