Provider Demographics
NPI:1083878433
Name:JEFFERY, JAMES I (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:I
Last Name:JEFFERY
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 1:833 S RIVEREDGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2018
Mailing Address - Country:US
Mailing Address - Phone:435-656-0035
Mailing Address - Fax:
Practice Address - Street 1:833 S RIVEREDGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2018
Practice Address - Country:US
Practice Address - Phone:435-656-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102418-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery