Provider Demographics
NPI:1104814680
Name:OVERCASH, JEFFREY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:OVERCASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6658
Mailing Address - Country:US
Mailing Address - Phone:619-955-5246
Mailing Address - Fax:619-656-9761
Practice Address - Street 1:752 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 105
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6658
Practice Address - Country:US
Practice Address - Phone:619-955-5246
Practice Address - Fax:619-656-9761
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0091008207PE0004X
CAA104007207P00000X
NC200400247207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270702100Medicaid
CABC061ZMedicare PIN
I17956Medicare UPIN
FL270702100Medicaid