MEDICARE: CHARLES A JEFFREYS JR. 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	207V00000X	Obstetrics & Gynecology Physician	H4971	TX

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

General Provider Information

NPI Number	:	1871587154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A JEFFREYS JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 152
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78291-0152
Country	:	US
Telephone Number	:	210-271-3910
Fax Number	:	210-682-9090

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4828
Country	:	US
Telephone Number	:	210-271-3910
Fax Number	:	210-682-9090

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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Directions to “ CHARLES A JEFFREYS JR. MD” Practice Location

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