Provider Demographics
NPI:1376584649
Name:JEFFREY, JOHN E JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:JEFFREY
Suffix:JR
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:PO BOX 862506
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2506
Mailing Address - Country:US
Mailing Address - Phone:913-754-0467
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:2901 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4056
Practice Address - Country:US
Practice Address - Phone:913-754-0467
Practice Address - Fax:913-341-5797
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83430207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10964OtherBLUE CROSS
FL265246300Medicaid
FLE57937Medicare UPIN
FLE6543WMedicare PIN
FL10964OtherBLUE CROSS
FL265246300Medicaid