Healthcare Provider Details

I. General information

NPI: 1922749951
Provider Name (Legal Business Name): JEFFERSON LAST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UVMMC 111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

UVMMC 111 COLCHESTER AVE
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2345
  • Fax:
Mailing address:
  • Phone: 802-847-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14266531-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: