Provider Demographics
NPI:1467239244
Name:TODD, JEFFREY ADAM JR (THW: PSS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ADAM
Last Name:TODD
Suffix:JR
Gender:M
Credentials:THW: PSS
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 1133
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0084
Mailing Address - Country:US
Mailing Address - Phone:541-200-3000
Mailing Address - Fax:
Practice Address - Street 1:213 S FIR ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3117
Practice Address - Country:US
Practice Address - Phone:541-292-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist