Provider Demographics
NPI:1588648760
Name:SELWYN, JEFFREY I (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:I
Last Name:SELWYN
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 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:702-778-2264
Practice Address - Street 1:5255 E WILLIAMS CIR STE 2020
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7454
Practice Address - Country:US
Practice Address - Phone:520-392-8400
Practice Address - Fax:520-393-3244
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0056650OtherBLUE CROSS BLUE SHIELD
002000167OtherCIGNA
1Z7528OtherHEALTHNET
110046359OtherRR MEDICARE
98982OtherPACIFICARE/SECURE HORIZNS
658936OtherUNITED HEALTHCARE
WMBHH08Medicare ID - Type Unspecified
AZ0056650OtherBLUE CROSS BLUE SHIELD