Provider Demographics
NPI:1174678908
Name:DEMERCURIO, JEFFREY STANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STANTON
Last Name:DEMERCURIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1425 HAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1136
Mailing Address - Country:US
Mailing Address - Phone:386-317-0444
Mailing Address - Fax:386-947-9004
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 500
Practice Address - Street 2:HALIFAX HEALTH MEDICAL CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2768
Practice Address - Country:US
Practice Address - Phone:386-258-3223
Practice Address - Fax:386-947-9004
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-09-25
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Provider Licenses
StateLicense IDTaxonomies
FLME101551208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000593400Medicaid
FL000593400Medicaid