Provider Demographics
NPI:1871717033
Name:JEFFERS, TERESA RENEE (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:RENEE
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11614 HURON LN STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1896
Mailing Address - Country:US
Mailing Address - Phone:501-221-1956
Mailing Address - Fax:501-219-2327
Practice Address - Street 1:11614 HURON LN STE A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1896
Practice Address - Country:US
Practice Address - Phone:501-221-1956
Practice Address - Fax:501-219-2327
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6518207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy