Provider Demographics
NPI:1568588549
Name:SMALL, JEFFREY SCOTT JR (PA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:SMALL
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:400 HIGHLAND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7003
Mailing Address - Country:US
Mailing Address - Phone:978-741-4133
Mailing Address - Fax:978-741-7742
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7003
Practice Address - Country:US
Practice Address - Phone:978-741-4133
Practice Address - Fax:978-741-7742
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-06-18
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Provider Licenses
StateLicense IDTaxonomies
MAAP2038363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ57930Medicare UPIN