Provider Demographics
NPI:1902998040
Name:JEFFREYS, KIRK R III (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:R
Last Name:JEFFREYS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1501 LAKELAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4834
Mailing Address - Country:US
Mailing Address - Phone:601-366-1085
Mailing Address - Fax:601-366-5186
Practice Address - Street 1:1501 LAKELAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4834
Practice Address - Country:US
Practice Address - Phone:601-366-1085
Practice Address - Fax:601-366-5186
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-08-13
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Provider Licenses
StateLicense IDTaxonomies
MS14957207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120588Medicaid
MSG90204Medicare UPIN
MS00120588Medicaid