Provider Demographics
NPI:1548225303
Name:DURFEE, ANTHONY JAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAY
Last Name:DURFEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 KEARNY VILLA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1151
Mailing Address - Country:US
Mailing Address - Phone:858-571-0606
Mailing Address - Fax:
Practice Address - Street 1:5471 KEARNY VILLA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1151
Practice Address - Country:US
Practice Address - Phone:858-571-0606
Practice Address - Fax:858-571-1933
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17641363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17163OtherMEDICARE PTAN
WPA17641AOtherMEDICARE PROVIDER ID
W17163OtherMEDICARE GROUP NUMBER
Q38147Medicare UPIN