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NPI Code Detail

MEDICARE: JEFFREY ROBERT DUFAULT DPM

MEDICARE: JEFFREY ROBERT DUFAULT DPM
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
1213ES0103XFoot & Ankle Surgery PodiatristE4021CA

General Provider Information

NPI Number : 1275504417
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY ROBERT DUFAULT DPM
Provider Business Mailing Address
First Line : 6493 E CAMINO GRANDE
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-4824
Country : US
Telephone Number : 904-891-8965
Fax Number :
Provider Business Practice Location Address
First Line : 1201 E 9TH ST
Second Line :
City : BONHAM
State : TX
Zip : 75418-4059
Country : US
Telephone Number : 214-857-4423
Fax Number : 214-857-0506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 11/27/2023

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Directions to “ JEFFREY ROBERT DUFAULT DPM” Practice Location

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