Provider Demographics
NPI:1235471319
Name:LIFE, JEFFRY SHOBE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:SHOBE
Last Name:LIFE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENTON DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1256
Mailing Address - Country:US
Mailing Address - Phone:702-289-6659
Mailing Address - Fax:
Practice Address - Street 1:1 KENTON DR
Practice Address - Street 2:SUITE 20
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1256
Practice Address - Country:US
Practice Address - Phone:702-289-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53595207Q00000X
WV11428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine