Provider Information for 1982729539
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DANIEL JANSEN
Sex: Male
NPI: 1982729539
Last Updated: 2022-09-09
Certification Date: 2022-09-09
Certification Date: 2022-09-09
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1982729539 | ||||||||
| Enumeration Date | 2007-03-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 931 CHEVY WAY MEDFORD, OR 97504-4127 United States Phone: 541-535-6239 | Fax: | ||||||||
| Primary Practice Address | 215 N ROSE ST PHOENIX, OR 97535 United States Phone: 541-535-1065 | Fax:541-512-2082 | ||||||||
| Secondary Practice Address(es) | 815 E JACKSON ST 713 SUMMIT AVE | ||||||||
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