Healthcare Provider Details

I. General information

NPI: 1407944234
Provider Name (Legal Business Name): JAMIE L. JEFFREY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TRACY WAY STE 2
CHARLESTON WV
25311-1262
US

IV. Provider business mailing address

600 TRACY WAY STE 2
CHARLESTON WV
25311-1262
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7782
  • Fax: 304-388-7788
Mailing address:
  • Phone: 304-388-7782
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberWV18284
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: