Provider Demographics
NPI:1861673105
Name:CHARLES JEFFREYS,MD PA
Entity Type:Organization
Organization Name:CHARLES JEFFREYS,MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFREYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-271-3910
Mailing Address - Street 1:1200 BROOKLYN AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4828
Mailing Address - Country:US
Mailing Address - Phone:210-271-3910
Mailing Address - Fax:210-541-0438
Practice Address - Street 1:1200 BROOKLYN AVE STE 245
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4828
Practice Address - Country:US
Practice Address - Phone:210-271-3910
Practice Address - Fax:210-541-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00668WMedicare PIN