Basic Information
| Provider Information | |||||||||
| NPI: | 1154641348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEFFREY | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 E 2ND ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568980 | ||||||||
| FaxNumber: | 8144510443 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E 2ND ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568980 | ||||||||
| FaxNumber: | 8144510443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD456800 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.