Provider Demographics
NPI:1194777508
Name:JEFFERSON, HENRY D (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:D
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1515 SW CARY PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6224
Mailing Address - Country:US
Mailing Address - Phone:919-387-3180
Mailing Address - Fax:919-387-3145
Practice Address - Street 1:1515 SW CARY PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-387-3180
Practice Address - Fax:919-387-3145
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NC26015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45881OtherBCBS
NC7945894Medicaid
AJ1641770OtherDEA
AJ1641770OtherDEA
C81377Medicare UPIN
NC7945894Medicaid