Provider Demographics
NPI:1407944234
Name:JEFFREY, JAMIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TRACY WAY
Mailing Address - Street 2:STE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1262
Mailing Address - Country:US
Mailing Address - Phone:304-388-7782
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:600 TRACY WAY
Practice Address - Street 2:STE 2
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1262
Practice Address - Country:US
Practice Address - Phone:304-388-7782
Practice Address - Fax:304-388-7788
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV18284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0110363000Medicaid
WVWV18284OtherWV LICENSE NUMBER
WV011036300Medicaid
WVH07150Medicare UPIN
WVWV1496B859Medicare PIN
WV0110363000Medicaid