Provider Demographics
NPI:1962470138
Name:CHEN, JEFFERY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:L
Last Name:CHEN
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 1:621 W HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3648
Mailing Address - Country:US
Mailing Address - Phone:360-477-1885
Mailing Address - Fax:
Practice Address - Street 1:530 BOGACHIEL WAY
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9120
Practice Address - Country:US
Practice Address - Phone:360-374-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022008699207R00000X
ORMD21256207R00000X
WAMD00043157208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1302CHOtherREGENCE BLUE SHIELD RIDER
WA8383812Medicaid
P00177921OtherRAILROAD MEDICARE
G72628Medicare UPIN
8801801Medicare ID - Type Unspecified