Provider Demographics
NPI:1861467946
Name:JEFFERSON, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:JEFFERSON
Suffix:
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:997 US HIGHWAY 41 BYP N
Practice Address - Street 2:SUITE 201
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6046
Practice Address - Country:US
Practice Address - Phone:941-952-4220
Practice Address - Fax:941-952-4222
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259226600Medicaid
FL35626OtherBCBS
FL35626WMedicare PIN
FL35626OtherBCBS