Provider Demographics
NPI:1518934991
Name:JEFFRIES, GLENN EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:JEFFRIES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1926 ALCOA HWY
Mailing Address - Street 2:BLDG. F, SUITE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1545
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:BLDG. F, SUITE 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1545
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD9044207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100020847OtherTENNCARE
TN4537213OtherAETNA
TN3165599Medicaid
TNTN0109OtherJOHN DEERE HEALTHCARE
TNTN0110OtherJOHN DEERE HEALTHCARE
TN200029548OtherRAILROAD MEDICARE
TNTN0178OtherJOHN DEERE HEALTHCARE
TN0940100OtherUNITED HEALTH CARE
TN3071399OtherBLUE CROSS BLUE SHIELD
TN103I206035Medicare PIN
TN3165594Medicare PIN
TN4537213OtherAETNA
TN3071399OtherBLUE CROSS BLUE SHIELD
3165592Medicare ID - Type Unspecified
TNTN0110OtherJOHN DEERE HEALTHCARE
TN200029548OtherRAILROAD MEDICARE
TN31655901Medicare PIN