Organization · NPI-2
Ab Jetmore MD LLC
Colon & Rectal Surgery · Lenexa, KS
NPI number1114258886
StatusActive
Last updated in NPPESDec 23, 2010
Details
- NPI
- 1114258886
- Entity type
- Organization (NPI-2)
- Legal business name
- Ab Jetmore MD LLC
- Organization subpart
- No
- Enumeration date
- Jan 20, 2010
- Last updated
- Dec 23, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208C00000X | Colon & Rectal Surgery | 04-24436 | KS | Yes |
Practice location
21106 W 95th TerLenexa, KS 66220-5600
Phone 913-322-8859 · Fax 888-778-9471
Mailing address
Po Box 7673Overland Park, KS 66207-0673
Phone 913-322-8859 · Fax 888-778-9471
Authorized official
Allen Bruce Jetmore
Sole Member
9138297716
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