Basic Information
| Provider Information | |||||||||
| NPI: | 1265532444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAUCH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 BREEZY HILL ROAD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027485126 | ||||||||
| FaxNumber: | 8027481107 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 BREEZY HILL ROAD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027485126 | ||||||||
| FaxNumber: | 8027481107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 5870 | NH | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | VT | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1047982 | 01 | VT | VT BCBS | OTHER | 0007982 | 05 | VT | MEDICAID | 0100833Y0VT01 | 01 | NH | ANTHEM BLUE SHIELD | OTHER | 04P012 | 01 | MVP | OTHER | 99007982 | 05 | NH | MEDICAID |