Jason G De Vries DPM

NPI 1609028422 - Podiatrist - 213ES0103X

NPI Details
NPI 1609028422
Gender Male
Enumeration Date 10/13/2008
Last Updated 03/22/2016
Entity Type Individual
Active Over 8 years ago
Practice Location
501 N 10TH ST
MANITOWOC WI, 54220-4039, US
Phone (920) 682-6376
Fax (920) 652-0115
Business Location
164 N BROADWAY
GREEN BAY WI, 54303-2728, US
Phone (920) 490-9046
Fax (920) 405-5388
Toxanomy
Taxonomy Code 213ES0103X
License State Wisconsin
License Number 940-025
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According to our database, Dr. Jason G De Vries DPM NPI is 1609028422, taxonomy code is 213ES0103X and license number is 940-025, license state is located at Wisconsin. Jason G De Vries DPM physically located at 501 N 10th St, Manitowoc WI, 54220-4039. NPI Number Jason G De Vries DPM has the Individual type.

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1609028422 NPI number is provided on an as is basis without warranty of any kind. 1609028422 is maintained by the National Plan & Provider Enumeration System. The contents of Jason G De Vries DPM are for informational purposes only.