Healthcare Provider Details

I. General information

NPI: 1801423934
Provider Name (Legal Business Name): JAY ATHERTON JEFFERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 COMMUNICATIONS PKWY STE 675
PLANO TX
75093-8162
US

IV. Provider business mailing address

3600 COMMUNICATIONS PKWY STE 675
PLANO TX
75093-8162
US

V. Phone/Fax

Practice location:
  • Phone: 972-473-7544
  • Fax:
Mailing address:
  • Phone: 972-473-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-10842
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberV8290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: