1477528313 NPI number — JOHN E FJERSTAD D.P.M.

Table of content: JOHN E FJERSTAD D.P.M. (NPI 1477528313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477528313 NPI number — JOHN E FJERSTAD D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FJERSTAD
Provider First Name:
JOHN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FJERSTAD
Provider Other First Name:
JOHN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477528313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1967 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINLEYVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95519-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-840-0226
Provider Business Mailing Address Fax Number:
707-840-0422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1967 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINLEYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95519-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-840-0226
Provider Business Practice Location Address Fax Number:
707-840-0422
Provider Enumeration Date:
02/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  DP00335 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: E4316 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)