Provider Demographics
NPI:1699449454
Name:JEFFCOAT, JOHN LUIS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LUIS
Last Name:JEFFCOAT
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:903-364-4525
Mailing Address - Fax:877-581-1491
Practice Address - Street 1:204 MEDICAL DR STE 240
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6372
Practice Address - Country:US
Practice Address - Phone:903-364-4525
Practice Address - Fax:877-581-1791
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant