Healthcare Provider Details

I. General information

NPI: 1922009372
Provider Name (Legal Business Name): RICHARD A. JANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/18/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

1160 PATTERSON RD SUITE 201
GRAND JUNCTION CO
81506-8275
US

IV. Provider business mailing address

PO BOX 62
GRAND JUNCTION CO
81502-0062
US

V. Phone/Fax

Practice location:
  • Phone: 970-255-6307
  • Fax: 970-244-7037
Mailing address:
  • Phone: 970-255-6307
  • Fax: 970-244-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDR-17729
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: