Basic Information
| Provider Information | |||||||||
| NPI: | 1346643103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY LARRY TOPKIS, D.O., INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15715 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926595715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495839944 | ||||||||
| FaxNumber: | 9495839955 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 HOSPITAL RD | ||||||||
| Address2: | 124 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926633522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496310988 | ||||||||
| FaxNumber: | 9496312504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | TOPKIS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | LARRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9496310988 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00AX44230 | 05 | CA | MEDICAID |