Provider Demographics
NPI:1649234345
Name:MUIR, JEFFREY W (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:MUIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:W
Other - Last Name:MUIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM PC
Mailing Address - Street 1:412 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1062
Mailing Address - Country:US
Mailing Address - Phone:570-586-0421
Mailing Address - Fax:570-586-5634
Practice Address - Street 1:412 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1062
Practice Address - Country:US
Practice Address - Phone:570-586-0421
Practice Address - Fax:570-586-5634
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003404L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011733390006Medicaid
PA0011733390006Medicaid
T87942Medicare UPIN