Organization
JACK L DEETJEN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NORMA JEAN ENGELMANN (OFFICE MANAGER)
(830) 379-8371
Entity
Organization
Contact information
Practice address
515 N KING, SUITE 106, SEGUIN, TX 78155-4815
(830) 379-8371
(830) 379-8378
Mailing address
515 N KING ST, SUITE 106, SEGUIN, TX 78155-4801
(830) 379-8371
(830) 379-8378
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
G4967
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033725501
—
TX
01
—
1699723320
N P I
—
Enumeration date
02/19/2008
Last updated
02/15/2024
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