Provider Demographics
NPI:1649297383
Name:SUDEITH, JEFFREY EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EDWARD
Last Name:SUDEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18231 IRVINE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3432
Mailing Address - Country:US
Mailing Address - Phone:714-389-5700
Mailing Address - Fax:714-389-6973
Practice Address - Street 1:18231 IRVINE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3432
Practice Address - Country:US
Practice Address - Phone:714-389-5700
Practice Address - Fax:714-389-6973
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50344207R00000X
MN251082083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine