Healthcare Provider Details

I. General information

NPI: 1861432759
Provider Name (Legal Business Name): JAY C JANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75B LIVINGSTON ST
ASHEVILLE NC
28801-4353
US

IV. Provider business mailing address

129 MCDOWELL ST
ASHEVILLE NC
28801-4434
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-8800
  • Fax: 828-281-7178
Mailing address:
  • Phone: 828-258-8800
  • Fax: 828-281-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9800917
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number9800917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: