Provider Demographics
NPI:1205420031
Name:BANFIELD, JEFFERY JACOB (RT(R))
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JACOB
Last Name:BANFIELD
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 AMBER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-9406
Mailing Address - Country:US
Mailing Address - Phone:606-545-8154
Mailing Address - Fax:
Practice Address - Street 1:17 AMBER DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-9406
Practice Address - Country:US
Practice Address - Phone:606-545-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5649722471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty