Provider Demographics
NPI:1942319645
Name:BURMEISTER, JEFFREY L (D P M P A)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:BURMEISTER
Suffix:
Gender:M
Credentials:D P M P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4659
Mailing Address - Country:US
Mailing Address - Phone:904-765-8889
Mailing Address - Fax:904-765-8989
Practice Address - Street 1:2762 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4659
Practice Address - Country:US
Practice Address - Phone:904-765-8889
Practice Address - Fax:904-765-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1913213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47DXFOtherFLORIDA BLUE
FL029720800Medicaid
FL47DXFOtherFLORIDA BLUE
T94330Medicare UPIN
65035Medicare ID - Type Unspecified