Provider Demographics
NPI:1639437981
Name:HAINSWORTH, JEFFREY THEODORE (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THEODORE
Last Name:HAINSWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1711
Mailing Address - Country:US
Mailing Address - Phone:949-631-9009
Mailing Address - Fax:
Practice Address - Street 1:2216 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1711
Practice Address - Country:US
Practice Address - Phone:949-631-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252638207R00000X
CA20A13308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine