Individual
DR. WILLIAM EMMETT JEFFERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 RIVERSIDE CIR, SUITE 105, ROANOKE, VA 24016-4961
(540) 581-0150
Mailing address
1 RIVERSIDE CIR, SUITE 105, ROANOKE, VA 24016-4961
(540) 581-0150
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101042761
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006606431
—
VA
01
—
220030578
RAILROAD MEDICARE
—
05
—
6600046000
—
WV
Enumeration date
07/20/2005
Last updated
05/26/2016
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