Provider Demographics
NPI:1669428827
Name:DEWEERD, JEFFREY SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:DEWEERD
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 1:710 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-8624
Mailing Address - Country:US
Mailing Address - Phone:517-244-1000
Mailing Address - Fax:517-604-6154
Practice Address - Street 1:710 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854
Practice Address - Country:US
Practice Address - Phone:517-244-1000
Practice Address - Fax:517-604-6154
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4510844Medicaid
MIP0027587OtherRR MEDICARE
MIP0027587OtherRR MEDICARE
H13134Medicare UPIN
MI4510844Medicaid