Provider Demographics
NPI:1972789618
Name:JEFFERSON, ROMANDA DENISE (DO)
Entity type:Individual
Prefix:DR
First Name:ROMANDA
Middle Name:DENISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ROMANDA
Other - Middle Name:DENISE
Other - Last Name:HUTSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:22422 BRIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2218
Mailing Address - Country:US
Mailing Address - Phone:281-392-1809
Mailing Address - Fax:
Practice Address - Street 1:22422 BRIDGEHAVEN DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2218
Practice Address - Country:US
Practice Address - Phone:281-392-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4457208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics