Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1083657 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | 1083657 | TX |
N | 2251H1200X | Hand | 1083657 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1083657 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1083657 | TX |
NPI | 1942350129 |
---|---|
Provider Name | Mr. Jeffrey Lawrence Jefferson |
First Address | Beaumont, TX 77705-8940 |
Second Address | Baytown, TX 77521-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T5135 | BCBS PROVIDER # (01) | TX |