Individual
MR. JEFFREY MICHAEL DITTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
100 MEDICAL PLZ, LAKE ST LOUIS, MO 63367-1366
(636) 625-5200
(636) 625-5314
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2017004715
MO
363L00000X
Nurse Practitioner
A155084
IA
Other
Enumeration date
03/15/2017
Last updated
01/13/2021
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