Basic Information
| Provider Information | |||||||||
| NPI: | 1861445157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEBUQUE | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 3800 SIERRA CIR | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | CENTER VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180348476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846642480 | ||||||||
| FaxNumber: | 4846642483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS006842L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0013929700004 | 05 | PA | MEDICAID | 110118140 | 01 | PA | PALMETTO RR | OTHER | 50004486 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 580372 | 01 | PA | HIGHMARK PA BLUE SHIELD | OTHER |