Healthcare Provider Details

I. General information

NPI: 1730113374
Provider Name (Legal Business Name): VIRGIL SINATRA JEFFERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
BILOXI MS
39534-2519
US

IV. Provider business mailing address

412 JORDAN DRIVE
BILOXI MS
39531-2309
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6495
  • Fax: 228-377-9170
Mailing address:
  • Phone: 228-377-6495
  • Fax: 228-377-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number4301045275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: