Organization
JEFFERSON UNIVERSITY PHYSICIAN
Active
Other names
Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN OGUNKEYE (EXECUTIVE DIRECTOR)
(215) 955-2562
Entity
Organization
Contact information
Practice address
833 CHESTNUT ST, SUITE 630, PHILADELPHIA, PA 19107-4414
(215) 955-0800
Mailing address
833 CHESTNUT ST, SUITE 630, PHILADELPHIA, PA 19107-4414
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1062654
KEYSTONE MERCY
PA
01
—
1153258
KEYSTONE MERCY
PA
01
—
1153628
KEYSTONE MERCY
PA
01
—
1153629
KEYSTONE MERCY
PA
01
—
1153651
KEYSTONE MERCY
PA
01
—
1153656
KEYSTONE MERCY
PA
01
—
1153665
KEYSTONE MERCY
PA
01
—
1156151
KEYSTONE MERCY
PA
01
—
1821657
HIGHMARK BLUE SHIELD
PA
01
—
2678933000
INDEPENDENCE BLUE CROSS
PA
01
—
507462
AETNA
PA
05
—
7512007
—
NJ
05
—
7531303
—
NJ
05
—
7531401
—
NJ
05
—
7535805
—
NJ
05
—
7550405
—
NJ
05
—
7551703
—
NJ
05
—
7585403
—
NJ
05
—
8455708
—
NJ
Enumeration date
04/17/2008
Last updated
04/28/2008
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