Individual
DR. JACK KENNETH DEITCHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
140 LITTON DRIVE, SUITE 110, GRASS VALLEY, CA 95945
(530) 274-8483
(530) 271-2067
Mailing address
140 LITTON DRIVE, SUITE 110, GRASS VALLEY, CA 95945
(530) 274-8483
(530) 271-2067
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
G26297
CA
Other
Enumeration date
07/28/2006
Last updated
03/05/2009
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