Individual
JEFFREY S. TIAHRT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1901 CONNECTICUT AVE. S, SARTELL, MN 56377
(320) 259-4100
(320) 257-5523
Mailing address
1901 CONNECTICUT AVE. S, SARTELL, MN 56377
(320) 259-4100
(320) 257-5523
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10396
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
970003410
—
MN
01
—
P00463430
RR MEDICAID
MN
Enumeration date
01/15/2008
Last updated
05/20/2020
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