MEDICARE: JESSE TOM PEURIFOY M.D.

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	174400000X	Specialist	24955	AL

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

General Provider Information

NPI Number	:	1831106459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE TOM PEURIFOY M.D.

Provider Business Mailing Address
First Line	:	1330 HIGHWAY 231 S
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-3058
Country	:	US
Telephone Number	:	334-670-5474
Fax Number	:	334-670-5446

Provider Business Practice Location Address
First Line	:	1340 HIGHWAY 231 S
Second Line	:	SUITE 5
City	:	TROY
State	:	AL
Zip	:	36081-3011
Country	:	US
Telephone Number	:	334-670-5568
Fax Number	:	334-670-5279

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	04/03/2017

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