Provider Demographics
NPI:1316957806
Name:ARNOLD, JEFFREY LEE (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:ARNOLD
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 1:460 TWIN PINES DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3920
Mailing Address - Country:US
Mailing Address - Phone:831-707-4745
Mailing Address - Fax:
Practice Address - Street 1:460 TWIN PINES DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3920
Practice Address - Country:US
Practice Address - Phone:831-707-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68735207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G687350Medicaid
CA00G687350Medicare PIN
CAE74647Medicare UPIN