Individual
DR. JERRY WILLIAM SAN DIEGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4101 S 4TH ST, P AND LMS, LEAVENWORTH, KS 66048-5014
(913) 682-2000
(913) 758-4193
Mailing address
4101 S 4TH ST, P AND LMS, LEAVENWORTH, KS 66048-5014
(913) 682-2000
(913) 758-4193
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
024399
LA
Other
Enumeration date
03/28/2006
Last updated
08/04/2014
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