Provider Demographics
NPI:1255911145
Name:BEDNARZ, JACEK JR (DO)
Entity type:Individual
Prefix:DR
First Name:JACEK
Middle Name:
Last Name:BEDNARZ
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S STATE ST STE 113
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4502
Mailing Address - Country:US
Mailing Address - Phone:605-225-0378
Mailing Address - Fax:
Practice Address - Street 1:105 S STATE ST STE 113
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4502
Practice Address - Country:US
Practice Address - Phone:605-225-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD15558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine