Provider Demographics
NPI:1639360381
Name:JEFFRIES, LUKE C (DPM)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:C
Last Name:JEFFRIES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:364 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1904
Mailing Address - Country:US
Mailing Address - Phone:603-668-3509
Mailing Address - Fax:603-641-8442
Practice Address - Street 1:424 HANOVER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-668-3509
Practice Address - Fax:603-641-8442
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1836213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1639360384OtherANTHEM BLUE CROSS BLUE SHIELD
5291500001Medicare NSC
NH1639360381Medicare PIN