Provider Demographics
NPI:1285988030
Name:JEFFERSON, JABRE D'ANTHONY
Entity type:Individual
Prefix:MR
First Name:JABRE
Middle Name:D'ANTHONY
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9623 COPPER SPRINGS
Mailing Address - Street 2:
Mailing Address - City:COVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109
Mailing Address - Country:US
Mailing Address - Phone:210-566-1592
Mailing Address - Fax:
Practice Address - Street 1:433 KITTY HAWK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3357
Practice Address - Country:US
Practice Address - Phone:210-566-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health