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NPI Code Detail

MEDICARE: DR. DONALD R JARY PHD

MEDICARE: DR. DONALD R JARY PHD
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
1103T00000XPsychologistPSY12654CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699701250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD R JARY PHD
Provider Business Mailing Address
First Line : 700 E REDLANDS BLVD # U269
Second Line :
City : REDLANDS
State : CA
Zip : 92373-6143
Country : US
Telephone Number : 858-205-5394
Fax Number :
Provider Business Practice Location Address
First Line : 1805 MEDICAL CENTER DR
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92411-1217
Country : US
Telephone Number : 858-205-5394
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 04/20/2009

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Directions to “ DR. DONALD R JARY PHD” Practice Location

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