Provider Demographics
NPI:1235397423
Name:JETER, MARVIN HOMER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:HOMER
Last Name:JETER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:15 NORTHTOWN DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3048
Mailing Address - Country:US
Mailing Address - Phone:601-956-8200
Mailing Address - Fax:601-956-8100
Practice Address - Street 1:15 NORTHTOWN DR
Practice Address - Street 2:SUITE G
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3048
Practice Address - Country:US
Practice Address - Phone:601-956-8200
Practice Address - Fax:601-956-8100
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-25
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
MS05361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine