Provider Demographics
NPI:1851338248
Name:GINTHER, JEFFREY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:GINTHER
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 1:246 MIDWAY MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1664
Mailing Address - Country:US
Mailing Address - Phone:423-989-0024
Mailing Address - Fax:423-989-7645
Practice Address - Street 1:246 MIDWAY MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1664
Practice Address - Country:US
Practice Address - Phone:423-989-0024
Practice Address - Fax:423-989-7645
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000012050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080097192OtherRR MEDICARE/PALMETTO GBA
VA242163OtherANTHEM
TN4175480Medicaid
44D0934620OtherCLIA
TN0014367OtherBCBS
VA5694442Medicaid
VA5694442Medicaid
TN3187663Medicare ID - Type Unspecified