Healthcare Provider Details

I. General information

NPI: 1730330762
Provider Name (Legal Business Name): ROBERT J JAUCH, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 BREEZY HILL RD
ST JOHNSBURY VT
05819-8882
US

IV. Provider business mailing address

714 BREEZY HILL RD
ST JOHNSBURY VT
05819-8882
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-5126
  • Fax: 802-748-1107
Mailing address:
  • Phone: 802-748-5126
  • Fax: 802-748-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number008425846
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number420006154
License Number StateVT

VIII. Authorized Official

Name: PATRICIA JAUCH
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-748-5126