Provider Demographics
NPI:1760783799
Name:JAHN, ERIC PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:JAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16204 ICE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2322
Mailing Address - Country:US
Mailing Address - Phone:952-475-2251
Mailing Address - Fax:
Practice Address - Street 1:16204 ICE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2322
Practice Address - Country:US
Practice Address - Phone:952-475-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5036207L00000X
MN28942207L00000X
WI23790207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology