Provider Demographics
NPI:1932393808
Name:MADER, JENNIFER RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RAY
Last Name:MADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LESLIE
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15383 43RD ST SW
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-4606
Mailing Address - Country:US
Mailing Address - Phone:320-286-3011
Mailing Address - Fax:
Practice Address - Street 1:15383 43RD ST SW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4606
Practice Address - Country:US
Practice Address - Phone:320-286-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine