Provider Demographics
NPI:1205056272
Name:WASHINGTON, JEFFREY B (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:STE 505
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2100
Mailing Address - Fax:231-487-6049
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:STE 505
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2100
Practice Address - Fax:231-487-6049
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301078087207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105186504Medicaid
MI2902410571OtherBCBS MI PIN
MI290B411070OtherBCBS MI GROUP PIN
MI105186504Medicaid