Healthcare Provider Details

I. General information

NPI: 1134104946
Provider Name (Legal Business Name): JEFFREY MCLEROY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST SUITE 3016
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

579 REGENCY PARK CIR
SACRAMENTO CA
95835-1735
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3771
  • Fax: 916-734-7946
Mailing address:
  • Phone: 916-734-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA87995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: