Individual
DR. BENJAMIN WELLS JADERHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1326 N STANFORD LN, LIBERTY LAKE, WA 99019-5034
(509) 838-2531
(509) 755-6580
Mailing address
PO BOX 3649, SPOKANE, WA 99220-3649
(509) 838-2531
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP60804314
WA
390200000X
Student in an Organized Health Care Education/Training Program
58.007627
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0159060
—
OH
Enumeration date
06/06/2014
Last updated
04/27/2018
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