Dehaven, Jordan Samuel

Dehaven, Jordan Samuel is an individual health care provider with primary practice located at 1180 Hope St , Bristol RI 02809-1126. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Dehaven, Jordan Samuel can be contacted via phone (401) 253-8900.

Contact Information

Primary practice address
1180 Hope St Bristol RI 02809-1126
Phone: (401) 253-8900
Fax: (401) 253-3131
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X DPM00328 Rhode Island

Profile Details

NPI number 1750510988
LBN Legal business name Dehaven, Jordan Samuel
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 9th, 2009
Last updated Oct 27th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750510988 NPPES
Rhode Island MEDICAID JD81548

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