Provider Demographics
NPI:1568487841
Name:DEMOSS, JEFFREY A (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:DEMOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1740 E FORT LOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2384
Practice Address - Country:US
Practice Address - Phone:520-613-0001
Practice Address - Fax:520-504-6482
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVDO2525207Q00000X
MI5101012101207Q00000X
AZ009674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1568487841Medicaid
MI3455425Medicaid
NVDO2525OtherSTATE LICENS