MEDICARE: DR. JETTIE M PERSON MD

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
1	207N00000X	Dermatology Physician	MD00022852	WA

General Provider Information

NPI Number	:	1720170723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JETTIE M PERSON MD

Provider Business Mailing Address
First Line	:	3834 49TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5234
Country	:	US
Telephone Number	:	206-234-5721
Fax Number	:

Provider Business Practice Location Address
First Line	:	3834 49TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5234
Country	:	US
Telephone Number	:	206-234-5721
Fax Number	:	206-729-9297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/17/2016

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