Provider Demographics
NPI:1295708139
Name:JETTON, TIMOTHY D (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:JETTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N US HIGHWAY 441 STE 930
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6812
Mailing Address - Country:US
Mailing Address - Phone:352-750-2108
Mailing Address - Fax:352-750-1836
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 930
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6812
Practice Address - Country:US
Practice Address - Phone:352-750-2108
Practice Address - Fax:352-750-1836
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23040Medicare UPIN