Provider Demographics
NPI:1861026288
Name:JEFF PODIATRY PA
Entity Type:Organization
Organization Name:JEFF PODIATRY PA
Other - Org Name:JEFF PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-432-7309
Mailing Address - Street 1:96098 VICTORIAS PL
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6349
Mailing Address - Country:US
Mailing Address - Phone:904-432-7309
Mailing Address - Fax:407-432-7281
Practice Address - Street 1:96096 VICTORIAS PL
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6349
Practice Address - Country:US
Practice Address - Phone:904-432-7309
Practice Address - Fax:904-432-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty