Theophil Jantz, D.O., Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

20A9193 Issued in CA

Legal business name

THEOPHIL JANTZ, D.O., INC

Practice address

721 River Dr
Ste B
Fort Bragg, CA 95437

Phone

(775) 747-5050

Fax

(775) 747-5005

NPI assigned

May 24, 2007

Organization subpart

No

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

Authorized official

Name

Theophil Jantz, D.O.

Title

Owner

Phone

(707) 964-6910

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902017932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895334120",
            "telephone_number": "775-747-5050",
            "fax_number": "775-747-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 RIVER DR",
            "address_2": "STE B",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "95437",
            "telephone_number": "775-747-5050",
            "fax_number": "775-747-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEOPHIL JANTZ, D.O., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JANTZ",
        "authorized_official_first_name": "THEOPHIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-964-6910",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "20A9193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.