Organization
AB JETMORE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN BRUCE JETMORE MD (SOLE MEMBER)
(913) 829-7716
Entity
Organization
Contact information
Practice address
21106 W 95TH TER, LENEXA, KS 66220-5600
(913) 322-8859
(888) 778-9471
Mailing address
PO BOX 7673, OVERLAND PARK, KS 66207-0673
(913) 322-8859
(888) 778-9471
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
04-24436
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4221151
AETNA
KS
01
—
42525017
BLUE SHIELD KANSAS CITY
MO
Enumeration date
01/20/2010
Last updated
12/23/2010
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