Individual
DR. DAVID LOUIS JETMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1434 CHESTER BLVD., RICHMOND, IN 47374-1919
(765) 966-1600
(765) 962-9641
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 983-3127
(765) 983-3219
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01023140A
IN
207Y00000X
Otolaryngology Physician
Primary
01023140A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000841132
ANTHEM
IN
05
—
0544192
—
OH
05
—
100256310
—
IN
Enumeration date
06/01/2005
Last updated
05/14/2021
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