MR. Theodore Basil Jerdes, LMP

NPI #1992251201 in Lacey, Washington

Provider Information

NPI Number: 1992251201
Entity Type: Individual
Name: MR. Theodore Basil Jerdes, LMP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: LMP
Enumeration Date: Aug 27, 2016
Last Updated: Aug 27, 2016

Practice Location

Address: 1210 SLEATER KINNEY RD SE
City: Lacey
State: Washington
ZIP Code: 98503-2316
Phone: (360) 352-4511

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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