Provider Demographics
NPI:1942655303
Name:DEL REAL, JEFFREY JULIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JULIAN
Last Name:DEL REAL
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 1:832 POWDERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3706
Mailing Address - Country:US
Mailing Address - Phone:648-593-8998
Mailing Address - Fax:
Practice Address - Street 1:832 POWDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3706
Practice Address - Country:US
Practice Address - Phone:648-593-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant