# JACK L DEETJEN MD

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790953289
- **Authorized official:** MRS. NORMA JEAN ENGELMANN (OFFICE MANAGER)
- **Authorized official phone:** (830) 379-8371

## Contact information

- **Practice address:** 515 N KING, SUITE 106, SEGUIN, TX 78155-4815
- **Practice address phone:** (830) 379-8371
- **Practice address fax:** (830) 379-8378
- **Mailing address:** 515 N KING ST, SUITE 106, SEGUIN, TX 78155-4801
- **Mailing address phone:** (830) 379-8371
- **Mailing address fax:** (830) 379-8378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | G4967 | TX | Yes |

## Other

- **Enumeration date:** 02/19/2008
- **Last updated:** 02/15/2024