Provider Demographics
NPI:1548671662
Name:DEFOOR, JEFFREY ALLAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:DEFOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5405
Mailing Address - Country:US
Mailing Address - Phone:256-766-3062
Mailing Address - Fax:256-767-1804
Practice Address - Street 1:409 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5405
Practice Address - Country:US
Practice Address - Phone:256-766-3062
Practice Address - Fax:256-767-1804
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine