William Emmett Jefferson III, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

0101042761 Issued in VA

Practice address

1 Riverside Cir
Suite 105
Roanoke, VA 24016-4961

Phone

(540) 581-0150

NPI assigned

Jul 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464220800000",
    "number": "1275532236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RIVERSIDE CIR",
            "address_2": "SUITE 105",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164961",
            "telephone_number": "540-581-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RIVERSIDE CIR",
            "address_2": "SUITE 105",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164961",
            "telephone_number": "540-581-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "WILLIAM",
        "middle_name": "EMMETT",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2016-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "VA",
            "license": "0101042761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "220030578",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006606431",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600046000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristie Jearls, RD
• Jebs Inc
• Jefferson Internal Medicine Associates, LTD
• Jefferson Surgical Clinic Inc
• Monique C Jefferson, AGACNP-BC
• David Lee Jeffries, AGACNP-BC
• Pamela Diane Jenkins, OTA
• Tyler Huntington-Reade Jenkins, D.O.
• Cathy Dickinson Jennings, DNP, RN
• Madolyn Grace Jennings

• Anatomic Pathology & Clinical Pathology Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.