Provider Demographics
NPI:1356331391
Name:JEFFRIES, BRENTLEY D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENTLEY
Middle Name:D
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 1:191 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4109
Mailing Address - Country:US
Mailing Address - Phone:828-254-0881
Mailing Address - Fax:828-350-3628
Practice Address - Street 1:191 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4109
Practice Address - Country:US
Practice Address - Phone:828-254-0881
Practice Address - Fax:828-350-3628
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32121207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45884OtherBCBS OF NC
NC8945884Medicaid
NC1407944OtherUNITED HEALTHCARE
NC207575AMedicare PIN
NC8945884Medicaid