Individual
MR. JOSEPH EDWARD JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS
Contact information
Practice address
3911 AVENUE B, SUITE 1100, SCOTTSBLUFF, NE 69361-4617
(308) 630-2100
(308) 630-2138
Mailing address
3911 AVENUE B, SUITE 1100, SCOTTSBLUFF, NE 69361-4617
(308) 630-2100
(308) 630-2138
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
355
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970017216
RR MEDICARE
NE
Enumeration date
08/05/2006
Last updated
11/07/2011
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