Provider Demographics
NPI:1982673612
Name:FROST, JEFFREY P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:FROST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1465 JOHNSTON WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-320-3668
Mailing Address - Fax:804-320-2600
Practice Address - Street 1:1465 JOHNSTON WILLIS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-320-3668
Practice Address - Fax:804-320-2600
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000669213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982673612Medicaid
VA1982673612Medicaid
VA012780F05Medicare PIN