Individual
JAY ALAN DETERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
855 12TH ST NW APT 206, VALLEY CITY, ND 58072-2042
(605) 830-0603
Mailing address
701 15TH ST SE APT 311, ORANGE CITY, IA 51041-1877
(605) 830-0603
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0700
SD
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700
CERTIFIED ATHLETIC TRAINER
SD
Enumeration date
04/02/2018
Last updated
03/25/2024
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