Organization
NORTHEAST TEXAS NEUROLOGY ASSOCIATES, P.A.
Active
Organization
NORTHEAST TEXAS NEUROLOGY ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA M. JETTER MD (PRESIDENT)
(903) 526-7055
Entity
Organization
Contact information
Practice address
505 S FLEISHEL AVE, TYLER, TX 75702-8413
(903) 526-7055
(903) 593-4303
Mailing address
505 S FLEISHEL AVE STE 800, TYLER, TX 75702-8413
(903) 526-7055
(903) 593-4303
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
E6235
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115025205
—
TX
05
—
143629701
—
TX
Enumeration date
11/01/2006
Last updated
08/16/2022
Update your record
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