Provider Demographics
NPI:1235140393
Name:JANA JADERBORG, MD, INC
Entity Type:Organization
Organization Name:JANA JADERBORG, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JADERBORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-332-5753
Mailing Address - Street 1:1900 NE 3RD ST
Mailing Address - Street 2:STE 106, RM # 317
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-332-5753
Mailing Address - Fax:541-749-2130
Practice Address - Street 1:1575 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-6821
Practice Address - Country:US
Practice Address - Phone:541-332-5753
Practice Address - Fax:541-749-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A771110Medicaid
CAZZZ23940ZMedicare ID - Type Unspecified
CA00A771110Medicaid