Provider Demographics
NPI:1326072893
Name:DEWEESE, JEFFREY ELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ELDON
Last Name:DEWEESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1199 BUSH ST
Mailing Address - Street 2:SUITE # 590
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5999
Mailing Address - Country:US
Mailing Address - Phone:415-292-2344
Mailing Address - Fax:415-931-2618
Practice Address - Street 1:1199 BUSH ST
Practice Address - Street 2:SUITE # 590
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5999
Practice Address - Country:US
Practice Address - Phone:415-292-2344
Practice Address - Fax:415-931-2618
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG682580208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943186775OtherTAX ID NUMBER
CAE36622Medicare UPIN
CA00G682580Medicare ID - Type UnspecifiedPROVIDER ID NUMBER