Healthcare Provider Details

I. General information

NPI: 1710947817
Provider Name (Legal Business Name): PAUL J JANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY ROAD SUITE 280
FLORENCE KY
41042
US

IV. Provider business mailing address

7370 TURFWAY ROAD SUITE 280
FLORENCE KY
41042
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-4567
  • Fax:
Mailing address:
  • Phone: 859-212-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberK18863
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: