Provider Demographics
NPI:1083705313
Name:SUSSMAN, JEFFREY EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EDWARD
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1444
Mailing Address - Country:US
Mailing Address - Phone:954-428-4800
Mailing Address - Fax:
Practice Address - Street 1:1979 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1444
Practice Address - Country:US
Practice Address - Phone:954-428-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD41948Medicare UPIN
FL94439Medicare ID - Type Unspecified
FL94439YMedicare PIN