Provider Demographics
NPI:1871521443
Name:DVERGSTEN, JEFFREY ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ARTHUR
Last Name:DVERGSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3941
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:2100 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3941
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45211208000000X
NC2010-013762080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN631T9DVOtherBCBS
MNHP37914OtherHEALTHPARTNERS
MN12-03423OtherMEDICA CHOICE
MN12-09026OtherMEDICA CHOICE
MN0597021Medicaid
MT0147475Medicaid
MN171323OtherUCARE
MN1864181OtherARAZ
WI34800400Medicaid
MN552443100Medicaid
MN1033631OtherPREFERRED ONE
WI34800400Medicaid
MN0597021Medicaid