MEDICARE: DR. JEFFREY A DEMOSS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO2525	NV
2	207Q00000X	Family Medicine Physician	5101012101	MI
3	207Q00000X	Family Medicine Physician	009674	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	DO2525	OTHER	NV	STATE LICENS

General Provider Information

NPI Number	:	1568487841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A DEMOSS DO

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 E FORT LOWELL RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2384
Country	:	US
Telephone Number	:	520-613-0001
Fax Number	:	520-504-6482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/07/2024

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Directions to “ DR. JEFFREY A DEMOSS DO” Practice Location

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