Provider Demographics
NPI:1942330568
Name:JEFFERSON UNDERWOOD, III, MD, PC
Entity Type:Organization
Organization Name:JEFFERSON UNDERWOOD, III, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:334-288-7531
Mailing Address - Street 1:2173 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111
Mailing Address - Country:US
Mailing Address - Phone:334-288-7531
Mailing Address - Fax:334-288-7539
Practice Address - Street 1:2173 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111
Practice Address - Country:US
Practice Address - Phone:334-288-7531
Practice Address - Fax:334-288-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528500430Medicaid
AL1659456606OtherNPI
AL51014552OtherBLUE CROSS
ALC74254Medicare UPIN