Individual
JETTER ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
909 FULTON ST SE, MINNEAPOLIS, MN 55455
(612) 672-7422
Mailing address
516 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0356
(612) 626-6519
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
63736
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2014
Last updated
05/15/2018
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