Individual
JONATHAN P JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
576 JEFFERSON AVE, FORT EUSTIS, VA 23604-1373
(757) 314-7500
(757) 314-7977
Mailing address
576 JEFFERSON AVE, FORT EUSTIS, VA 23604-1373
(757) 314-2037
(577) 314-7977
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
R1052
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101279523
VIRGINIA MEDICAL LICENSE
VA
01
—
R1052
TEXAS MEDICAL LICENSE
TX
Enumeration date
06/19/2015
Last updated
10/27/2023
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