MEDICARE: HENDRIK JOHANNES DE JAGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A252550	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043398282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENDRIK JOHANNES DE JAGER M.D.

Provider Business Mailing Address
First Line	:	1850 S WATERMAN AVE
Second Line	:	SUITE A
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:	909-796-2525
Fax Number	:	909-824-2028

Provider Business Practice Location Address
First Line	:	1850 S WATERMAN AVE
Second Line	:	SUITE A
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:	909-796-2525
Fax Number	:	909-824-2028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	06/24/2010

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