Provider Demographics
NPI:1235939596
Name:DEBRUYN, JEFFREY THOMAS
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:DEBRUYN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 23RD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1568
Mailing Address - Country:US
Mailing Address - Phone:248-953-0469
Mailing Address - Fax:
Practice Address - Street 1:1950 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1529
Practice Address - Country:US
Practice Address - Phone:248-953-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker