Provider Demographics
NPI:1831106459
Name:PEURIFOY, JESSE TOM (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:TOM
Last Name:PEURIFOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 HIGHWAY 231 S
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3058
Mailing Address - Country:US
Mailing Address - Phone:334-670-5474
Mailing Address - Fax:334-670-5446
Practice Address - Street 1:1340 HIGHWAY 231 S
Practice Address - Street 2:SUITE 5
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3011
Practice Address - Country:US
Practice Address - Phone:334-670-5568
Practice Address - Fax:334-670-5279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934676Medicaid
D85707Medicare UPIN
AL051557111Medicare ID - Type Unspecified