Provider Demographics
NPI:1306003819
Name:JEFFRIES, CHRISTOPHER CARSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CARSON
Last Name:JEFFRIES
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 1:4110 COPPER RIDGE DR
Mailing Address - Street 2:SUITE 242
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6722
Mailing Address - Country:US
Mailing Address - Phone:231-929-7700
Mailing Address - Fax:231-929-7709
Practice Address - Street 1:4110 COPPER RIDGE DR
Practice Address - Street 2:SUITE 242
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6722
Practice Address - Country:US
Practice Address - Phone:231-929-7700
Practice Address - Fax:231-929-7709
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080398174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306003819Medicaid
MI2402811442OtherBCBS
MIP30000004Medicare PIN