Provider Demographics
NPI:1891974044
Name:ERIC W. JAHNKE MD INC
Entity Type:Organization
Organization Name:ERIC W. JAHNKE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-922-6991
Mailing Address - Street 1:1311 S MILLER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6900
Mailing Address - Country:US
Mailing Address - Phone:805-922-6991
Mailing Address - Fax:
Practice Address - Street 1:1311 S MILLER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6900
Practice Address - Country:US
Practice Address - Phone:805-922-6991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40086207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G400860Medicaid
GA100000707OtherRAILROAD MEDICARE
CA00G400860Medicaid