MEDICARE: JEFFERY GOFTON

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	209800000X	Legal Medicine (M.D./D.O.) Physician	0101243476	VA

General Provider Information

NPI Number	:	1629969530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY GOFTON

Provider Business Mailing Address
First Line	:	400 E JACKSON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-1438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E JACKSON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-1438
Country	:	US
Telephone Number	:	804-786-3174
Fax Number	:

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

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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