Provider Demographics
NPI:1669421889
Name:JEPMA, JOHN W (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:JEPMA
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 1:161 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5303
Mailing Address - Country:US
Mailing Address - Phone:386-424-1584
Mailing Address - Fax:386-410-4800
Practice Address - Street 1:161 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5303
Practice Address - Country:US
Practice Address - Phone:386-424-1584
Practice Address - Fax:386-410-4800
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354316Medicaid
NY00354316Medicaid