Provider Demographics
NPI:1861484511
Name:MACE, JEFFREY G (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:MACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:598 BROWNS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0334
Mailing Address - Country:US
Mailing Address - Phone:831-724-1811
Mailing Address - Fax:831-724-1866
Practice Address - Street 1:242 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3137
Practice Address - Country:US
Practice Address - Phone:831-724-1811
Practice Address - Fax:831-724-1866
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2013-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG32527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G325270Medicaid
A45184Medicare UPIN
CA00G325270Medicaid