Jefferson Physician Network, LLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

2009008025 Issued in MO

Legal business name

JEFFERSON PHYSICIAN NETWORK, LLC

Practice address

1105 W Liberty St
Farmington, MO 63640-1921

Phone

(636) 933-2900

Fax

(636) 933-8017

NPI assigned

Feb 1, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Jeff Buck

Title

Interiem Chief Executive Officer

Phone

(636) 933-1000

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1568734994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 350",
            "city": "CRYSTAL CITY",
            "state": "MO",
            "postal_code": "630190350",
            "telephone_number": "636-933-1299",
            "fax_number": "636-933-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 W LIBERTY ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401921",
            "telephone_number": "636-933-2900",
            "fax_number": "636-933-8017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PHYSICIAN NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "INTERIEM CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "636-933-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "2009008025",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "2010010722",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MO",
            "license": "2009017530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1558508606",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tamra Lee Jackson
• Courtney Jacobs
• Daniel Jaderko, PHARMD
• Lynn S James, MA. LPC
• Mikayla James, NP
• Kristin R Jennings, DNP
• Jesse Beard Orthopedics LLC
• Shane Jinkerson
• Crystal Johannsson, MPT
• John P. Jackson D.D.S., P.C.

• Endocrinology, Diabetes & Metabolism Physician in Farmington, MO
• Providers in Farmington, MO by specialty
• Endocrinology, Diabetes & Metabolism Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.