MEDICARE: DR. SCOTT RYAN JEANSONNE D.O.

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	207Q00000X	Family Medicine Physician	A-1580-10	NM

General Provider Information

NPI Number	:	1902034879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT RYAN JEANSONNE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 912678
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-2678
Country	:	US
Telephone Number	:	505-241-5182
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 DON PASQUAL RD NW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-8841
Country	:	US
Telephone Number	:	505-873-7400
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	05/14/2025

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