Basic Information
| Provider Information | |||||||||
| NPI: | 1518934991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEFFRIES | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1926 ALCOA HWY | ||||||||
| Address2: | BLDG. F, SUITE 210 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462663 | ||||||||
| FaxNumber: | 8655469047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1926 ALCOA HWY | ||||||||
| Address2: | BLDG. F, SUITE 210 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462663 | ||||||||
| FaxNumber: | 8655469047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 10/25/2013 | ||||||||
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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 | 207X00000X | MD9044 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100020847 | 01 | TN | TENNCARE | OTHER | 4537213 | 01 | TN | AETNA | OTHER | 3165599 | 05 | TN | MEDICAID | TN0109 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | TN0110 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 200029548 | 01 | TN | RAILROAD MEDICARE | OTHER | TN0178 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 0940100 | 01 | TN | UNITED HEALTH CARE | OTHER | 3071399 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |