1265454417 NPI number — JEFFREY B PERSONS M.D.

Table of content: JEFFREY B PERSONS M.D. (NPI 1265454417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265454417 NPI number — JEFFREY B PERSONS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERSONS
Provider First Name:
JEFFREY
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265454417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2012 MEADE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23434-4259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-673-5680
Provider Business Mailing Address Fax Number:
757-539-5735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 MEADE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23434-4259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-673-5680
Provider Business Practice Location Address Fax Number:
757-539-5735
Provider Enumeration Date:
07/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0101039588 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200028102 . This is a "MEDICARE RR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006405339 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00799126 . This is a "RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".