Provider Demographics
NPI:1003995754
Name:MULLER, JEFFERY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALAN
Last Name:MULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAGNOLIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3332
Mailing Address - Country:US
Mailing Address - Phone:951-735-9211
Mailing Address - Fax:
Practice Address - Street 1:2815 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2533
Practice Address - Country:US
Practice Address - Phone:951-735-9211
Practice Address - Fax:951-735-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52888305R00000X
CAG5288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52379Medicare UPIN