Individual
DR. THOMAS S JETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
303 W HARRIS AVE, STE 2, SAN ANGELO, TX 76903-6377
(325) 658-6519
(325) 658-6510
Mailing address
303 W HARRIS AVE STE 2, P O BOX 3602, SAN ANGELO, TX 76903-6377
(325) 658-6519
(325) 658-6510
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9602
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
F1680
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T570
BCBS
—
Enumeration date
08/10/2005
Last updated
01/06/2011
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