Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 11509 | AL |
NPI | 1033570783 |
---|---|
Provider Name | Dr. Debra C Jeffries |
First Address | Land O Lakes, FL 34637-7851 |
Second Address | Land O Lakes, FL 34637-7851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 09/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11509 | STATE LICENSE (01) | AL |