Doctor Name: | DR. ALLEN BRUCE JETMORE |
NPI Number: | 1093725111 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 0424436 |
Business Practice Address: | 11111 Nall Ave Suite 116 Leawood, KS - 662111924 |
Business Phone Number: | 9134510600 |
Business Fax Number: | 9134510601 |
Mailing Address: | 11111 Nall Ave, Suite 116 LEAWOOD |
State: | KS |
Postal Code: | 662111924 |
Phone Number: | 9134510600 |
Fax Number: | 9134510601 |
NPI Enumeration Date: | 08/09/2006 |
NPI Last Update Date: | 08/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 0424436 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |