Individual
DR. JEREMY RUSSELL CEFALU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1327 TROUP HWY, TYLER, TX 75701
(903) 606-4733
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R2073
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371443805
—
TX
01
—
693517
MEDICARE
TX
01
—
8JX800
BCBS
TX
Enumeration date
04/11/2013
Last updated
10/12/2018
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