Provider Demographics
NPI:1184678286
Name:JEFFRIES, RHONDA DETERT (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:DETERT
Last Name:JEFFRIES
Suffix:
Gender:F
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:PO BOX 3492
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CT
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:678-938-3900
Mailing Address - Fax:
Practice Address - Street 1:5600 S QUEBEC ST
Practice Address - Street 2:312A
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2207
Practice Address - Country:US
Practice Address - Phone:303-436-2727
Practice Address - Fax:303-426-2710
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI61549Medicare UPIN