Provider Demographics
NPI:1063464733
Name:MUHA, JEFFREY P (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:MUHA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11271
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 FREEDOM BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6074
Practice Address - Country:US
Practice Address - Phone:843-674-1480
Practice Address - Fax:843-674-6411
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC128213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890805VMedicaid
SC480015152OtherRAILROAD MEDICARE
SCPD1288Medicaid
SCU133422669Medicare PIN
SCU13342Medicare UPIN