Provider Demographics
NPI:1346422532
Name:JETTER, GINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:JETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:505 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8413
Mailing Address - Country:US
Mailing Address - Phone:903-526-7055
Mailing Address - Fax:
Practice Address - Street 1:505 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8413
Practice Address - Country:US
Practice Address - Phone:903-526-7055
Practice Address - Fax:903-593-4303
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN08652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology