Provider Demographics
NPI:1568748101
Name:PROPHETE, JEFFREY EMANNUEL
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:EMANNUEL
Last Name:PROPHETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CASHMAN PL
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1733
Mailing Address - Country:US
Mailing Address - Phone:781-510-9136
Mailing Address - Fax:
Practice Address - Street 1:7 CABOT PL STE 3B
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4631
Practice Address - Country:US
Practice Address - Phone:857-227-9101
Practice Address - Fax:866-494-2027
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program