Provider Demographics
NPI:1386612190
Name:BIRCHALL, JEFFERSON CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:CHARLES
Last Name:BIRCHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:488 E VALLEY PKWY
Mailing Address - Street 2:411
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3363
Mailing Address - Country:US
Mailing Address - Phone:760-745-2000
Mailing Address - Fax:760-745-0451
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:310
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-745-2000
Practice Address - Fax:760-745-0451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG071876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG071876OtherSTATE LICENSE
CAG071876OtherSTATE LICENSE
CAWG71876AMedicare ID - Type Unspecified