Provider Demographics
NPI:1508683517
Name:JETTON, RYAN DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:JETTON
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2 HELM CT
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1737
Mailing Address - Country:US
Mailing Address - Phone:949-400-7183
Mailing Address - Fax:
Practice Address - Street 1:3333 N CALVERT ST STE 600
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6504
Practice Address - Country:US
Practice Address - Phone:410-467-7665
Practice Address - Fax:410-467-7746
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2025-12-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant