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
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