Provider Demographics
NPI:1952783888
Name:JEFFCOAT, DONOVAN BLACKWOOD (DO)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:BLACKWOOD
Last Name:JEFFCOAT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1150 E SHERMAN BLVD STE 2400
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1886
Mailing Address - Country:US
Mailing Address - Phone:231-672-6336
Mailing Address - Fax:231-672-6335
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-728-4601
Practice Address - Fax:231-728-4783
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021948204D00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM