Provider Demographics
NPI:1023093168
Name:GEFTER, JEFFREY W (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:GEFTER
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 1:979 E 3RD ST
Mailing Address - Street 2:SUITE G-20
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-756-0018
Mailing Address - Fax:423-265-2045
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE G-20
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-756-0018
Practice Address - Fax:423-265-2045
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN141832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051052Medicaid
GA458598AMedicaid
TN2006290OtherBC/BS PROVIDER NUMBER
TN62-1138684OtherTAX ID
GA458598AMedicaid
TN3051052Medicare ID - Type Unspecified