Provider Demographics
NPI:1104622588
Name:JEFFERSON, WILLIAM HOWARD SR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HOWARD
Last Name:JEFFERSON
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 CORBY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3322
Mailing Address - Country:US
Mailing Address - Phone:402-594-9037
Mailing Address - Fax:
Practice Address - Street 1:2887 CORBY ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3322
Practice Address - Country:US
Practice Address - Phone:402-594-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor