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NPI Code Detail

MEDICARE: DR. MADHAVI JEFFERSON M.D.

MEDICARE: DR. MADHAVI JEFFERSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianU0368TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00143004OTHERILRAILROAD MEDICARE

General Provider Information

NPI Number : 1043290489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MADHAVI JEFFERSON M.D.
Provider Business Mailing Address
First Line : 6210 E HWY 290 STE 240
Second Line :
City : AUSTIN
State : TX
Zip : 78723-1144
Country : US
Telephone Number : 512-483-9596
Fax Number : 512-406-6216
Provider Business Practice Location Address
First Line : 11714 WILSON PARKE AVE STE 150
Second Line :
City : AUSTIN
State : TX
Zip : 78726-4061
Country : US
Telephone Number : 512-346-6611
Fax Number : 512-406-6267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 10/10/2023

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