MEDICARE: DR. BRENDA L JEFFERSON-BYRD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-099715	IL

General Provider Information

NPI Number	:	1285717595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA L JEFFERSON-BYRD MD

Provider Business Mailing Address
First Line	:	3700 BAYBROOK DR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-6596
Country	:	US
Telephone Number	:	630-202-8189
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 E NEW YORK ST STE 115
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-4466
Country	:	US
Telephone Number	:	630-499-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/12/2023

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