Basic Information
| Provider Information | |||||||||
| NPI: | 1386612190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIRCHALL | ||||||||
| FirstName: | JEFFERSON | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 488 E VALLEY PKWY | ||||||||
| Address2: | 411 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607452000 | ||||||||
| FaxNumber: | 7607450451 | ||||||||
| Practice Location | |||||||||
| Address1: | 488 E VALLEY PKWY | ||||||||
| Address2: | 310 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607452000 | ||||||||
| FaxNumber: | 7607450451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G071876 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | G071876 | 01 | CA | STATE LICENSE | OTHER |