Provider Demographics
NPI:1942761325
Name:LEDFORD, JEREMY WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WAYNE
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6253
Mailing Address - Country:US
Mailing Address - Phone:334-610-2222
Mailing Address - Fax:334-203-1060
Practice Address - Street 1:101 24TH ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6253
Practice Address - Country:US
Practice Address - Phone:334-610-2222
Practice Address - Fax:334-203-1060
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALDO2588207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program