Provider Demographics
NPI:1265476592
Name:CUOMO, JEFFREY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEVEN
Last Name:CUOMO
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:P.O. BOX 580
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-0580
Mailing Address - Country:US
Mailing Address - Phone:205-221-5374
Mailing Address - Fax:205-384-1453
Practice Address - Street 1:2950 HWY 78 EAST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-221-5374
Practice Address - Fax:205-384-1453
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054631207X00000X
AL29533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38201900Medicaid
MD747M302FMedicare ID - Type UnspecifiedM.D.
MD38201900Medicaid