Provider Demographics
NPI:1407299126
Name:HASSENFLUG, JEFFREY ALLYN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLYN
Last Name:HASSENFLUG
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 1:2081 BRIARBEND CT
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5833
Mailing Address - Country:US
Mailing Address - Phone:816-567-3372
Mailing Address - Fax:
Practice Address - Street 1:2081 BRIARBEND CT
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5833
Practice Address - Country:US
Practice Address - Phone:816-567-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ9370207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program