Individual
DR. ALLEN BRUCE JETMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11111 NALL AVE, SUITE 116, LEAWOOD, KS 66211-1924
(913) 451-0600
(913) 451-0601
Mailing address
11111 NALL AVE, SUITE 116, LEAWOOD, KS 66211-1924
(913) 451-0600
(913) 451-0601
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0424436
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18198056
BCBS OF KANSAS CITY
MO
Enumeration date
08/09/2006
Last updated
08/29/2011
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