Provider Demographics
NPI:1902034879
Name:JEANSONNE, SCOTT RYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RYAN
Last Name:JEANSONNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:145 DON PASQUAL RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8841
Mailing Address - Country:US
Mailing Address - Phone:505-865-4618
Mailing Address - Fax:505-224-8727
Practice Address - Street 1:145 DON PASQUAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8841
Practice Address - Country:US
Practice Address - Phone:505-873-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1580-10207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine