Provider Demographics
NPI:1861445157
Name:DEBUQUE, JEFFERY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:A
Last Name:DEBUQUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:3800 SIERRA CIR
Practice Address - Street 2:SUITE 115
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8476
Practice Address - Country:US
Practice Address - Phone:484-664-2480
Practice Address - Fax:484-664-2483
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006842L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013929700004Medicaid
PA110118140OtherPALMETTO RR
PA50004486OtherCAPITAL BLUE CROSS
PA580372OtherHIGHMARK PA BLUE SHIELD
PAE40983Medicare UPIN
PA580372H9MMedicare PIN