Individual
DR. EDWARD L JANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2555 MARVIN RD NE, PMG SW WA HAWKS PRAIRIE IM, LACEY, WA 98516-3138
(360) 923-4600
(360) 923-4663
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00025461
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201569
LABOR AND INDRUSTRIES
WA
01
—
4764JA
REGENCE
WA
01
—
5389380
AETNA
WA
05
—
8304495
—
WA
Enumeration date
07/10/2006
Last updated
05/25/2021
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