Individual
LARRY JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6621 FANNIN ST, WT 6-006, HOUSTON, TX 77030-2316
(832) 824-6230
(832) 825-2967
Mailing address
6621 FANNIN ST, WT 6-006, HOUSTON, TX 77030-2303
(832) 824-6230
(832) 825-2967
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
G2400
TX
2080P0214X
Pediatric Pulmonology Physician
Primary
G2400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134850003
—
TX
Enumeration date
10/17/2006
Last updated
09/17/2015
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