Provider Demographics
NPI:1720283948
Name:DR. JEFF L. MCLEOD, P.C.
Entity Type:Organization
Organization Name:DR. JEFF L. MCLEOD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-763-1058
Mailing Address - Street 1:5001 W VILLAGE GREEN DR STE 108
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4801
Mailing Address - Country:US
Mailing Address - Phone:804-763-1058
Mailing Address - Fax:804-763-2693
Practice Address - Street 1:5001 W VILLAGE GREEN DR STE 108
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4801
Practice Address - Country:US
Practice Address - Phone:804-763-1058
Practice Address - Fax:804-763-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09433Medicare PIN