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General NPI Number Information
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NPI Number | 1902017668
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Entity Type | Organization
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Legal Business Name | JEFFERSON ORTHOPEDIC GROUP
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 834 SHERIDAN ST
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-2443
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Country | US
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Telephone | 360-344-3090
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Fax | 360-344-3089
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Provider Business Mailing Address
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Address Line | 834 SHERIDAN ST
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-2443
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Country | US
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Telephone | 360-344-3090
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Fax | 360-344-3089
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Authorized Official
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Title or Position | ALAN GREENWALD OWNER
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Name | DR. ALAN GREENWALD
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Credential | MD
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Telephone | 360-344-0400
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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 | MD00017256
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License Number State | WA
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