Provider Demographics
NPI:1386691558
Name:JEFFERDS, ANN (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:JEFFERDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 TENTH AVE
Mailing Address - Street 2:SUITE #160
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2853
Mailing Address - Country:US
Mailing Address - Phone:801-408-5151
Mailing Address - Fax:801-408-3598
Practice Address - Street 1:UNIVERSITY OF UTAH MEDICAL CENTER 50 NORTH # 160
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2853
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181614-1205207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9200041OtherUNITED HEALTH CARE #
UT224997OtherALTIUS PROVIDER NUMBER
UT29652OtherPEHP PROVIDER #
UT010133899OtherTEAMSTERS #
UT110182384OtherRAILROAD EMPS INS ID
UT870623071OtherMOLINA PROVIDER #
UT005559501Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
UT29652OtherPEHP PROVIDER #