MEDICARE: CHARLES JEFFREYS,MD PA

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
1	207V00000X	Obstetrics & Gynecology Physician	H4971	TX

General Provider Information

NPI Number	:	1861673105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES JEFFREYS,MD PA

Provider Business Mailing Address
First Line	:	1200 BROOKLYN AVE STE 245
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4828
Country	:	US
Telephone Number	:	210-271-3910
Fax Number	:	210-541-0438

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE STE 245
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4828
Country	:	US
Telephone Number	:	210-271-3910
Fax Number	:	210-541-0438

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES JEFFREYS
Credential	:	MD
Telephone Number	:	210-271-3910

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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