Jeffry Shobe Life, MD, PHD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11428 Issued in WV

Practice address

1 Kenton Dr
Suite 20
Charleston, WV 25311-1256

Phone

(702) 289-6659

NPI assigned

Mar 26, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1235471319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 KENTON DR",
            "address_2": "SUITE 20",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111256",
            "telephone_number": "702-289-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KENTON DR",
            "address_2": "SUITE 20",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111256",
            "telephone_number": "702-289-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIFE",
        "first_name": "JEFFRY",
        "middle_name": "SHOBE",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-26",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C53595",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "11428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Diane Leyda, PR
• Yongchang Li, DO
• Mary Licodo
• Allison Liddle
• Life Touch Transport, LLC
• Lifestance Health - West Virginia, PLLC Dba Lifestance Health
• Ruth Liggett
• Sarah Liggett
• Erin Light, MD
• Krisena Light

• Family Medicine Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.