Individual
MR. BRIAN WILLIAM JANSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
640 DR MARY MCLEOD BETHUNE BLVD, DAYTONA BEACH, FL 32114-3012
(386) 481-2261
(386) 481-2265
Mailing address
1610 3RD ST, DAYTONA BEACH, FL 32117-4556
(386) 341-3666
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AL 571
FL
Other
Enumeration date
02/27/2006
Last updated
07/08/2007
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