Individual
JEFFREY P SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7154
(260) 435-7633
Mailing address
3240B MALLARD COVE LN, FORT WAYNE, IN 46804-2883
(260) 432-5867
(260) 436-9013
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1028175
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100348010
—
IN
01
—
220011660
RAILROAD
—
Enumeration date
07/06/2006
Last updated
01/28/2011
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