Basic Information
Provider Information
NPI: 1174576136
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAFNER
FirstName: JEFFERY
MiddleName: LYNN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19556 CRYSTAL ROCK DR
Address2: #23
City: GERMANTOWN
State: MD
PostalCode: 208744945
CountryCode: US
TelephoneNumber: 2406023297
FaxNumber:  
Practice Location
Address1: NNMC
Address2: 8901 WISCONSIN AVENUE
City: BETHESDA
State: MD
PostalCode: 208890001
CountryCode: US
TelephoneNumber: 3012954455
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/18/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XD0059755MDY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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