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Individual
JAY ALAN DETERMAN
Active
Individual
JAY ALAN DETERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0700
SD
363A00000X
Physician Assistant
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700
CERTIFIED ATHLETIC TRAINER
SD
Enumeration date
04/02/2018
Last updated
03/25/2024
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