Provider Demographics
NPI:1578542007
Name:MCGILBRA, JEFFREY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOUIS
Last Name:MCGILBRA
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:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342
Mailing Address - Country:US
Mailing Address - Phone:601-646-7700
Mailing Address - Fax:601-646-7800
Practice Address - Street 1:5000 HIGHWAY 39 NORTH
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-453-5493
Practice Address - Fax:888-735-7202
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS186332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
531981OtherVALUE OPTIONS
MS02479791Medicaid
I16594Medicare UPIN
531981OtherVALUE OPTIONS