Individual
JACK L DEETJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 N KING ST, SUITE 106, SEGUIN, TX 78155-4815
(830) 379-8371
(830) 379-8378
Mailing address
515 N KING ST, SUITE 106, SEGUIN, TX 78155-4815
(830) 379-8371
(830) 379-8378
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G4967
TX
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00H38Y
BCBS
TX
05
—
033725501
—
TX
Enumeration date
05/05/2006
Last updated
08/01/2024
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