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NPI Code Detail

MEDICARE: DR. JEFFREY MICHAEL DIFFENDERFER MD, MPH

MEDICARE: DR. JEFFREY MICHAEL DIFFENDERFER MD, MPH
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
12083P0901XPublic Health & General Preventive Medicine Physician01070055AIN
22083X0100XOccupational Medicine Physician01070055AIN

General Provider Information

NPI Number : 1114249463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY MICHAEL DIFFENDERFER MD, MPH
Provider Business Mailing Address
First Line : 6600 VAN AALST BLVD
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2102
Country : US
Telephone Number : 762-408-1304
Fax Number :
Provider Business Practice Location Address
First Line : 6600 VAN AALST BLVD
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2102
Country : US
Telephone Number : 762-408-1304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2010
Last Update Date : 12/12/2025

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