DR. THEODORE JOSEPH JERDEE M.D. NPI 1104806397

NPI Information

NPI: 1104806397
Provider Name: DR. THEODORE JOSEPH JERDEE, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
101 BODIN CIR
60 MDG/SGQX
TRAVIS AFB, CA
ZIP 94535
Phone: (707) 423-7182
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DR. Theodore Joseph Jerdee, M.D. is a diagnostic radiology radiology in Travis Afb, CA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Theodore Joseph Jerdee, M.D. NPI is 1104806397. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

101 BODIN CIR
60 MDG/SGQX
TRAVIS AFB, CA
ZIP 94535-809
Phone: (707) 423-7182

The NPI 1104806397 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/23/2006 and was last updated on 7/25/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		22461	OKLAHOMA	No
2	2085R0202X	Radiology	Diagnostic Radiology	C53747	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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