Provider Demographics
NPI:1376537696
Name:JANSSEN, GERRIET ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERRIET
Middle Name:ARTHUR
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:ARTHUR
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3390 N CAMPBELL AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2380
Mailing Address - Country:US
Mailing Address - Phone:520-795-7650
Mailing Address - Fax:520-325-1622
Practice Address - Street 1:3390 N CAMPBELL AVE
Practice Address - Street 2:STE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2380
Practice Address - Country:US
Practice Address - Phone:520-795-7650
Practice Address - Fax:520-325-1622
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8152207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ05WCHGG11Medicare ID - Type Unspecified
AZE00278Medicare UPIN