Provider Demographics
NPI:1871694273
Name:JEFFREY, ROBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:JEFFREY
Suffix:
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 1:4401 S 650 W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1548
Mailing Address - Country:US
Mailing Address - Phone:812-342-1050
Mailing Address - Fax:812-342-9620
Practice Address - Street 1:10331 W POND DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1548
Practice Address - Country:US
Practice Address - Phone:812-342-1050
Practice Address - Fax:812-342-9620
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025377A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351443638OtherTRICARE
IN100051970Medicaid
INP00067427OtherRAILROAD MEDICARE
IN000000084043OtherANTHEM BLUE CROSS
IN000000084043OtherANTHEM BLUE CROSS
INC24197Medicare UPIN