Provider Demographics
NPI:1689750325
Name:WAYNE, JEFFREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:WAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:160 GATEWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3318
Mailing Address - Country:US
Mailing Address - Phone:916-434-8230
Mailing Address - Fax:916-434-8237
Practice Address - Street 1:160 GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3318
Practice Address - Country:US
Practice Address - Phone:916-434-8230
Practice Address - Fax:916-434-8237
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB99171Medicare UPIN
B99171Medicare UPIN
CA00G659090Medicare ID - Type Unspecified