Provider Demographics
NPI:1417307653
Name:JEFFERSON, RYAN CHESSMAN (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CHESSMAN
Last Name:JEFFERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7971
Mailing Address - Country:US
Mailing Address - Phone:614-545-7900
Mailing Address - Fax:614-545-7901
Practice Address - Street 1:6810 PERIMETER DR STE 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8013
Practice Address - Country:US
Practice Address - Phone:614-827-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132795207X00000X, 207XP3100X, 207XS0106X, 208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0036475Medicaid
OHH0028308OtherCGS