Provider Demographics
NPI:1144255654
Name:ALFERINK, JEFFERSON D (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:D
Last Name:ALFERINK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SIXTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2360
Mailing Address - Country:US
Mailing Address - Phone:231-392-0640
Mailing Address - Fax:231-392-0643
Practice Address - Street 1:1221 SIXTH ST STE 300
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-392-0640
Practice Address - Fax:231-392-0643
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004454OtherPHYS. ASST. LICENSE
MI1307011752OtherBCBSM
JA004454OtherSTATE LICENSE
MI5601004454OtherPHYS. ASST. LICENSE
MIH06003062Medicare ID - Type Unspecified