| Doctor Name: | DR. THEODORE JOSEPH JERDEE |
| NPI Number: | 1104806397 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 22461 |
| Business Practice Address: | 101 Bodin Cir 60 Mdg/sgqx Travis Afb, CA - 945351809 |
| Business Phone Number: | 7074237182 |
| Business Fax Number: | |
| Mailing Address: | 101 Bodin Cir, 60 Mdg/sgqx TRAVIS AFB |
| State: | CA |
| Postal Code: | 945351809 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2006 |
| NPI Last Update Date: | 07/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 22461 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |