Provider Demographics
NPI:1932195468
Name:JADERLUND, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:JADERLUND
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 1:2401 W OAK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2381
Mailing Address - Country:US
Mailing Address - Phone:940-387-2241
Mailing Address - Fax:940-380-1374
Practice Address - Street 1:2401 W OAK ST STE 102
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2381
Practice Address - Country:US
Practice Address - Phone:940-387-2241
Practice Address - Fax:940-380-1374
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5207208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120308505Medicaid
TX120308503Medicaid
TX120308507Medicaid
TX120308506Medicaid
TX120308508Medicaid
TX120308501Medicaid
TX120308508Medicaid
TX120308503Medicaid
TX120308507OtherMEDICAID OTHER
TX120308506Medicaid