Doctor Name: | DR. THOMAS T JEFFERSON |
NPI Number: | 1790891448 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | C4604 |
Business Practice Address: | 1100 N University Ave Suite 260 Little Rock, AR - 722076343 |
Business Phone Number: | 5016030003 |
Business Fax Number: | 5016030030 |
Mailing Address: | 1100 N University Ave, Suite 260 LITTLE ROCK |
State: | AR |
Postal Code: | 722076343 |
Phone Number: | 5016030003 |
Fax Number: | 5016030030 |
NPI Enumeration Date: | 08/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C4604 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |