Individual
DR. LISA ELEANOR JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4106 PORTSMOUTH BLVD, PORTSMOUTH, VA 23701-2968
(757) 393-1136
(757) 698-2499
Mailing address
4106 PORTSMOUTH BLVD, PORTSMOUTH, VA 23701-2968
(757) 393-1136
(757) 698-2499
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102050078
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219614
ANTHEM BCBS
VA
01
—
54208
OPTIMA HEALTH
VA
Enumeration date
06/04/2006
Last updated
12/30/2020
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