Provider Demographics
NPI:1619920469
Name:JEFFERIES, JOHN LYNN JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LYNN
Last Name:JEFFERIES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 1000 DEPT 960
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:901-260-1704
Practice Address - Street 1:1211 UNION AVE STE 965
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-435-8550
Practice Address - Fax:901-516-0933
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35096072207RC0000X
MS26120207RC0000X, 2080P0202X
MN602452080P0202X
KY333762080P0202X
OH35.0960722080P0202X
TN578882080P0202X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology