Individual
MR. JUSTIN ZACKARY JEFFUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
950 W COY SMITH HWY, MOUNT VERNON, AL 36560-3201
(251) 829-9884
(251) 829-9507
Mailing address
PO BOX 2867, MOBILE, AL 36652-2867
(251) 690-8158
(251) 544-2188
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5934 CI
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP NUMBER
AL
01
—
1063439065
PAYEE NPI GROUP NUMBER
AL
05
—
630000013
—
AL
Enumeration date
06/20/2012
Last updated
06/20/2012
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