Provider Demographics
NPI:1629216528
Name:FUTCH, JEFFERSON PEARCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:PEARCE
Last Name:FUTCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 HILDEN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8401
Mailing Address - Country:US
Mailing Address - Phone:904-615-1853
Mailing Address - Fax:904-615-1873
Practice Address - Street 1:145 HILDEN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8401
Practice Address - Country:US
Practice Address - Phone:904-615-1853
Practice Address - Fax:904-615-1873
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001085213E00000X
FLPO3392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist