Jack L Deetjen MD

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

G4967 Issued in TX

Legal business name

JACK L DEETJEN MD

Practice address

515 N King
Suite 106
Seguin, TX 78155-4815

Phone

(830) 379-8371

Fax

(830) 379-8378

NPI assigned

Feb 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Norma Jean Engelmann

Title

Office Manager

Phone

(830) 379-8371

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1790953289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N KING ST",
            "address_2": "SUITE 106",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781554801",
            "telephone_number": "830-379-8371",
            "fax_number": "830-379-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N KING",
            "address_2": "SUITE 106",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781554815",
            "telephone_number": "830-379-8371",
            "fax_number": "830-379-8378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK L DEETJEN MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "ENGELMANN",
        "authorized_official_first_name": "NORMA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "830-379-8371",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "G4967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033725501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N P I",
            "identifier": "1699723320",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Hunt, D.D.S.
• Ana Magdalena Ibarra Noriega
• Darvin John Villarico Ignacio, ATC, LAT
• Isaac Isak, PHARMACIST
• Nicholas Israel
• Jack L Deetjen MD PLLC
• Logan Nicole Jahns, FNP
• James C Lee MD
• James E. Glenewinkel, Glenewinkel Sales Service, Mobility Store & More
• Jane Tomlinson Dba Behavioral Therapy Clinic

• Durable Medical Equipment & Medical Supplies in Seguin, TX
• Providers in Seguin, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.