Provider Demographics
NPI:1093894198
Name:JANSSEN, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1502 E RED RIVER ST
Mailing Address - Street 2:#347
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5523
Mailing Address - Country:US
Mailing Address - Phone:361-576-9812
Mailing Address - Fax:361-574-1580
Practice Address - Street 1:2807 N BEN WILSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5730
Practice Address - Country:US
Practice Address - Phone:361-576-9812
Practice Address - Fax:361-574-1580
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG34942085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125696802Medicaid
TX760387962OtherEMPLOYER ID - ROAGC
TX920000190OtherRAIL ROAD MEDICARE
TX742569553OtherEMPLOYER ID - ROAST
TX88R662OtherBLUE CROSS/SHIELD - ROAGC
TX125696801Medicaid
TX85R632OtherBLUE CROSS/SHIELD - ROAST
TX88R662Medicare ID - Type UnspecifiedGROUP #00K53D
TX920000190OtherRAIL ROAD MEDICARE
TX85R632Medicare ID - Type UnspecifiedGROUP #00F16E