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Individual

DR. DAVID L JANSSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2807 N BEN WILSON ST, SUITE 201, VICTORIA, TX 77901-5730
(361) 576-9812
(361) 574-1580
Mailing address
1502 E RED RIVER ST, #347, VICTORIA, TX 77901-5523
(361) 576-9812
(361) 574-1580

Taxonomy

Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
G3494
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
125696801
TX
05
125696802
TX
01
742569553
EMPLOYER ID - ROAST
TX
01
760387962
EMPLOYER ID - ROAGC
TX
01
85R632
BLUE CROSS/SHIELD - ROAST
TX
01
88R662
BLUE CROSS/SHIELD - ROAGC
TX
01
920000190
RAIL ROAD MEDICARE
TX
Enumeration date
11/02/2006
Last updated
02/02/2010
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