Healthcare Provider Details

I. General information

NPI: 1831486810
Provider Name (Legal Business Name): JACOB C DEISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAKE C DEISTER M.D.

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

IV. Provider business mailing address

2660 SW 3RD ST
TOPEKA KS
66606-2442
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-8880
  • Fax:
Mailing address:
  • Phone: 785-270-8880
  • Fax: 785-270-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number04-39039
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: