Provider Demographics
NPI:1457330797
Name:RITTER, JETHRO TREES (DO)
Entity Type:Individual
Prefix:
First Name:JETHRO
Middle Name:TREES
Last Name:RITTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-540-0689
Mailing Address - Fax:
Practice Address - Street 1:1551 BISHOP ST STE 250
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4661
Practice Address - Country:US
Practice Address - Phone:805-540-0689
Practice Address - Fax:805-541-4376
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8407207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH82712Medicare UPIN