Provider Demographics
NPI:1003005117
Name:JEFFREY M. DEMBNER, MD, INC.
Entity Type:Organization
Organization Name:JEFFREY M. DEMBNER, MD, INC.
Other - Org Name:NEWPORT NEUROSURGERY, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:DEMBNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-697-8897
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-5906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3226
Practice Address - Country:US
Practice Address - Phone:714-639-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74580207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16861OtherMEDICARE PTAN
CAW16861OtherMEDICARE PTAN