Healthcare Provider Details

I. General information

NPI: 1760680631
Provider Name (Legal Business Name): JEFFERY M KLCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-6807
  • Fax:
Mailing address:
  • Phone: 901-595-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2007017953
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number50957
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: