Individual
JUSTIN PARKER JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15507 NW 67TH AVE, MIAMI LAKES, FL 33014-2108
(305) 821-8611
(305) 827-1753
Mailing address
900 S PINE ISLAND RD STE 800, PLANTATION, FL 33324-3923
(305) 821-8611
(305) 827-1753
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME140375
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103107800
—
FL
Enumeration date
04/26/2016
Last updated
06/18/2019
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