Individual
JACOB VANDERSTARRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
890 OAK ST SE BLDG A, SALEM, OR 97301
(855) 691-9890
Mailing address
890 OAK ST SE BLDG A, SALEM, OR 97301-3905
(855) 691-9890
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301109907
MI
207P00000X
Emergency Medicine Physician
Primary
MD191574
OR
Other
Enumeration date
06/24/2016
Last updated
06/21/2019
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