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NPI Code Detail

MEDICARE: BENJAMIN ALAN JETER P.A.

MEDICARE: BENJAMIN ALAN JETER P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA-160AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151520839OTHERALBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1255304473
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN ALAN JETER P.A.
Provider Business Mailing Address
First Line : 1801 GADSDEN HWY
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35235-3134
Country : US
Telephone Number : 205-838-3900
Fax Number : 205-838-3906
Provider Business Practice Location Address
First Line : 1801 GADSDEN HWY
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35235-3134
Country : US
Telephone Number : 205-838-3900
Fax Number : 205-838-3906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 05/13/2016

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Directions to “ BENJAMIN ALAN JETER P.A.” Practice Location

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