Individual
MR. THEODORE BASIL JERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1210 SLEATER KINNEY RD SE, LACEY, WA 98503-2316
(360) 352-4511
(360) 754-4703
Mailing address
1210 SLEATER KINNEY RD SE, LACEY, WA 98503-2316
(360) 352-4511
(360) 754-4703
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60597586
WA
Other
Enumeration date
08/27/2016
Last updated
08/27/2016
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