Provider Demographics
NPI:1851402549
Name:DUKEMAN, JEFFREY L (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:DUKEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-7900
Mailing Address - Fax:406-257-0253
Practice Address - Street 1:111 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3164
Practice Address - Country:US
Practice Address - Phone:406-752-7900
Practice Address - Fax:406-257-0253
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA2582363A00000X
MT399363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000096143OtherBLUE CROSS
MT1851402549Medicaid
MT000096143OtherBLUE CROSS
Q30994Medicare UPIN