Provider Demographics
NPI:1396165288
Name:UY, JEFFERSON (MT ASCP)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:
Last Name:UY
Suffix:
Gender:M
Credentials:MT ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2821
Mailing Address - Country:US
Mailing Address - Phone:415-312-7730
Mailing Address - Fax:
Practice Address - Street 1:547 EDINBURGH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2821
Practice Address - Country:US
Practice Address - Phone:415-312-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09229246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV09229OtherLABORATORY TECHNOLOGIST
3568OtherASCP
CAMTA00045207OtherCCLS
FLTN46183OtherFLORIDA CLINICAL LABORATORY TECHNOLOGIST