Provider Demographics
NPI:1750479465
Name:SWEENEY, JEFFREY CLIFTON (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CLIFTON
Last Name:SWEENEY
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 1:9305 PINECROFT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3482
Mailing Address - Country:US
Mailing Address - Phone:713-897-7005
Mailing Address - Fax:
Practice Address - Street 1:17189 I 45 S STE 105
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3320
Practice Address - Country:US
Practice Address - Phone:936-270-4971
Practice Address - Fax:936-270-4972
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2020207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155575703Medicaid
TXH75244Medicare UPIN
GAP00020921Medicare PIN
TX8A7166Medicare PIN