MEDICARE: JAYSON R MIEDEMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2012-00940	NC

General Provider Information

NPI Number	:	1134354814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYSON R MIEDEMA MD

Provider Business Mailing Address
First Line	:	410 MARKET ST STE 400
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4061
Country	:	US
Telephone Number	:	984-974-3692
Fax Number	:	984-974-3900

Provider Business Practice Location Address
First Line	:	410 MARKET ST STE 400
Second Line	:	DEPARTMENT OF DERMATOLOGY
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4061
Country	:	US
Telephone Number	:	919-966-2485
Fax Number	:	919-966-6460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2009
Last Update Date	:	04/01/2021

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