Provider Demographics
NPI:1366682130
Name:JEFFREY L. BURMEISTER, DPM, P.A.
Entity Type:Organization
Organization Name:JEFFREY L. BURMEISTER, DPM, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-765-8889
Mailing Address - Street 1:2762 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4659
Mailing Address - Country:US
Mailing Address - Phone:904-765-8889
Mailing Address - Fax:904-765-8989
Practice Address - Street 1:2762 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4659
Practice Address - Country:US
Practice Address - Phone:904-765-8889
Practice Address - Fax:904-765-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1913213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47DXFOtherFLORIDA BLUE
FL029720800Medicaid
FL47DXFOtherFLORIDA BLUE
FL029720800Medicaid
FL0139850002Medicare NSC