Provider Demographics
NPI:1003849902
Name:JEFFRIES, RICHARD HALEY (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HALEY
Last Name:JEFFRIES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:4830 LONDONDERRY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5207
Practice Address - Country:US
Practice Address - Phone:717-657-2595
Practice Address - Fax:717-657-3091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002605L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007160810001Medicaid
PA0007160810001Medicaid
PA0716081Medicaid
PAD77448Medicare UPIN
PA50001734OtherCAPITAL BLUE CROSS