Provider Demographics
NPI:1043397698
Name:STILLSON, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:STILLSON
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 1:68 SWEETEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2318
Mailing Address - Country:US
Mailing Address - Phone:828-274-9567
Mailing Address - Fax:828-255-2865
Practice Address - Street 1:68 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2318
Practice Address - Country:US
Practice Address - Phone:828-274-9567
Practice Address - Fax:828-255-2865
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000-26057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8980075Medicaid
NC8980075Medicaid
NC210720HMedicare ID - Type UnspecifiedPROVIDER NUMBER