Provider Demographics
NPI:1821254467
Name:WETMORE, JEREMY CALVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CALVIN
Last Name:WETMORE
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 1:420 W MORRIS BLVD STE 400D
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2282
Mailing Address - Country:US
Mailing Address - Phone:423-586-7509
Mailing Address - Fax:423-581-5701
Practice Address - Street 1:420 W MORRIS BLVD STE 400D
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2282
Practice Address - Country:US
Practice Address - Phone:423-586-7509
Practice Address - Fax:423-581-5701
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO2336208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529705Medicaid