Provider Demographics
NPI:1992819619
Name:WIDMEYER, JEFFREY H (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:WIDMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2325
Mailing Address - Country:US
Mailing Address - Phone:434-847-5347
Mailing Address - Fax:434-316-7008
Practice Address - Street 1:7626 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2325
Practice Address - Country:US
Practice Address - Phone:434-847-5347
Practice Address - Fax:434-316-7008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049993208600000X, 2086S0129X, 174400000X
VA0101049932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7187888OtherAETNA
VA176753OtherANTHEM
VA462534OtherSOUTHERN HEALTH
VAP00237590OtherRAILROAD MEDICARE
VA176753OtherANTHEM