Provider Demographics
NPI:1255331476
Name:BLOOD, JEFFREY R (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:BLOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:614 RAVENNA ST
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3028
Mailing Address - Country:US
Mailing Address - Phone:941-483-9730
Mailing Address - Fax:941-483-9745
Practice Address - Street 1:1790 E VENICE AVE STE 102
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3191
Practice Address - Country:US
Practice Address - Phone:941-483-9730
Practice Address - Fax:941-483-9745
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME94683208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001861600Medicaid
FLA80680Medicare UPIN
FL001861600Medicaid