Provider Demographics
NPI:1629062625
Name:MEFFERD, JEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:MEFFERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:916 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7815
Mailing Address - Country:US
Mailing Address - Phone:760-599-9545
Mailing Address - Fax:760-599-9549
Practice Address - Street 1:9888 GENESEE AVE
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1276
Practice Address - Country:US
Practice Address - Phone:858-626-6864
Practice Address - Fax:760-599-9549
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG501612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G501610Medicaid
CA00G501610Medicaid
CAWG50161BMedicare PIN