Healthcare Provider Details

I. General information

NPI: 1275506362
Provider Name (Legal Business Name): JEFFREY JOHN POKORNY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N ROAD ST SUITE K
ELIZABETH CITY NC
27909-3354
US

IV. Provider business mailing address

1141 N ROAD ST SUITE K
ELIZABETH CITY NC
27909-3354
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-2293
  • Fax: 252-331-2387
Mailing address:
  • Phone: 252-335-2293
  • Fax: 252-331-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2009-01310
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD418843
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: