MEDICARE: DR. CHRISTOPHER CARSON JEFFRIES M.D.

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	174400000X	Specialist	4301080398	MI
2	208200000X	Plastic Surgery Physician	4301080398	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2402811442	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1306003819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER CARSON JEFFRIES M.D.

Provider Business Mailing Address
First Line	:	4110 COPPER RIDGE DR
Second Line	:	SUITE 242
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6722
Country	:	US
Telephone Number	:	231-929-7700
Fax Number	:	231-929-7709

Provider Business Practice Location Address
First Line	:	4110 COPPER RIDGE DR
Second Line	:	SUITE 242
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6722
Country	:	US
Telephone Number	:	231-929-7700
Fax Number	:	231-929-7709

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	03/01/2019

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