=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205116357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ANN JEFFREY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2011
-----------------------------------------------------
Last Update Date | 08/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 N CAMPBELL AVE RM 6336
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85724-5040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-626-2761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | EMILY JEFFREY 3300 N PASEO DE LOS RIOS APT 21101
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-756-4697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 49737
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 49737
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------