1417955956 NPI number — JEFFREY P APPEL M.D.

Table of content: JEFFREY P APPEL M.D. (NPI 1417955956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417955956 NPI number — JEFFREY P APPEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
APPEL
Provider First Name:
JEFFREY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417955956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-313-5258
Provider Business Mailing Address Fax Number:
205-313-5299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N BONITA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401-3623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-313-5258
Provider Business Practice Location Address Fax Number:
205-313-5298
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  ME61185 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 370903500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6064780700 . This is a "DOL GRP#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 18246 . This is a "BCBSF GRP# 98513" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME61185 . This is a "LICENSE# EXP:01/31/07" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101556900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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