Provider Demographics
NPI:1023360823
Name:ROY, JEFFERY J (CPO)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:J
Last Name:ROY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9698
Mailing Address - Country:US
Mailing Address - Phone:906-353-7161
Mailing Address - Fax:906-353-7000
Practice Address - Street 1:1229 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3186
Practice Address - Country:US
Practice Address - Phone:906-353-7161
Practice Address - Fax:906-353-7000
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist