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Organization
MK JEFFERSON MD ANESTHESIA SERVICS, INC.
Active
Organization
MK JEFFERSON MD ANESTHESIA SERVICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL K. JEFFERSON MD (PRESIDENT)
(818) 885-8500
Entity
Organization
Contact information
Practice address
18300 ROSCOE BLVD, NORTHRIDGE, CA 91325-4105
(818) 885-8500
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G68903C
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
G68903C
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G689030
BLUE SHIELD
CA
Enumeration date
12/03/2007
Last updated
12/03/2007
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