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General NPI Number Information
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NPI Number | 1699496042
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Entity Type | Individual
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Provider Name | BYRON M JEFFERSON
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Gender | Male
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 3088 N RIDGE
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City | CRANDALL
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State | TX
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Zip | 75114-5132
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Country | US
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Telephone | 214-448-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 3088 N RIDGE
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City | CRANDALL
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State | TX
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Zip | 75114-5132
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Country | US
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Telephone | 214-448-4684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 08113743
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License Number State | TX
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