Provider Demographics
NPI:1871587154
Name:JEFFREYS, CHARLES A JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:JEFFREYS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0152
Mailing Address - Country:US
Mailing Address - Phone:210-271-3910
Mailing Address - Fax:210-682-9090
Practice Address - Street 1:1200 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4828
Practice Address - Country:US
Practice Address - Phone:210-271-3910
Practice Address - Fax:210-682-9090
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122703505Medicaid
TXE18090Medicare UPIN
TX00668WMedicare ID - Type Unspecified