Organization
TED H JEFFERSON D.O., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TED H JEFFERSON D.O. (PRESIDENT)
(270) 442-2449
Entity
Organization
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
—
000000200944
ANTHEM
KY
01
—
5044430001
DMERC
KY
Enumeration date
07/20/2006
Last updated
08/22/2020
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