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General NPI Number Information
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NPI Number | 1760473284
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Entity Type | Individual
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Provider Name | JEFFREY J GLEASON MD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 145 W. 4TH STREET SUITE 201
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-783-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 127 N. OAK AVENUE SUITE D
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-783-5857
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Fax | 931-526-6760
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD0000023618
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License Number State | TN
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