Individual
TED H JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2605 KENTUCKY AVE, DOB#3 SUITE 602, PADUCAH, KY 42003-3800
(270) 442-2449
(270) 442-6628
Mailing address
2605 KENTUCKY AVE, DOB#3 SUITE 602, PADUCAH, KY 42003-3800
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
02703
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000200948
ANTHEM
KY
05
—
64032436
—
KY
Enumeration date
07/25/2006
Last updated
07/08/2007
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