Provider Demographics
NPI:1821090408
Name:PAKULA, JEFFREY L (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:PAKULA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13634 N 93RD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4915
Mailing Address - Country:US
Mailing Address - Phone:623-815-2484
Mailing Address - Fax:623-815-2483
Practice Address - Street 1:13634 N 93RD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4915
Practice Address - Country:US
Practice Address - Phone:623-815-2484
Practice Address - Fax:623-815-2483
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ386351Medicaid
63601Medicare ID - Type Unspecified
AZ386351Medicaid