Provider Demographics
NPI:1962081489
Name:ST. JEOR, JEFFERY DALE (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DALE
Last Name:ST. JEOR
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 1:6215 HAMPTONBURG RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8293
Mailing Address - Country:US
Mailing Address - Phone:801-400-7288
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST BAPTIST MEDICAL CENTER MEDICAL CENTER BOULE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-3932
Practice Address - Fax:336-716-3861
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRTL21-0542207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery