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General NPI Number Information
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NPI Number | 1487820189
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Entity Type | Individual
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Provider Name | JEFFREY BRYAN VANDEUSEN M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 269 PORTLAND WAY S
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City | GALION
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State | OH
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Zip | 44833-2312
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Country | US
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Telephone | 419-462-3470
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Fax | 419-468-5184
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Provider Business Mailing Address
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Address Line | 700 N COLUMBUS ST
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City | CRESTLINE
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State | OH
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Zip | 44827-1455
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Country | US
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Telephone | 419-462-3485
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Fax | 419-468-5184
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 134714
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 098460
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 35098460
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License Number State | OH
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