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General NPI Number Information
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NPI Number | 1306834643
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Entity Type | Individual
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Provider Name | JAN OLOF DAHLIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1118 NW 16TH ST SUITE C
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City | FRUITLAND
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State | ID
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Zip | 83619-2271
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Country | US
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Telephone | 208-452-2510
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Fax | 208-452-2513
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Provider Business Mailing Address
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Address Line | 1118 NW 16TH ST SUITE C
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City | FRUITLAND
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State | ID
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Zip | 83619-2271
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Country | US
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Telephone | 208-452-2510
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Fax | 208-452-2513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M-6608
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD13079
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License Number State | OR
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