Most Relevant Information
Provider Data
| NPI Number: | 1003267782 |
| Provider Name: | JACOB VANDERSTARRE M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 207P00000X |
| Specialty: | Emergency Medicine |
| License Number: | 4301109907 |
Most Important Dates
| Enumeration Date: | 06/24/2016 |
| Last Updated: | 06/21/2019 |
Provider Practice Location
890 OAK ST SE BLDG A
SALEM
OR
97301
Practice Location Phone/Fax
| Phone: | 8556919890 |
| Fax: |
Provider Mailing Location
890 OAK ST SE BLDG A
SALEM
OR
973013905
Provider Mailing Phone/Fax
| Phone: | 8556919890 |
| Fax: |