Provider Demographics
NPI:1275587388
Name:SONN, JEFFREY R (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:SONN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8791 CONFERENCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-938-3506
Mailing Address - Fax:
Practice Address - Street 1:63 BARKLEY CIR
Practice Address - Street 2:STE. 100 & 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4514
Practice Address - Country:US
Practice Address - Phone:239-938-3500
Practice Address - Fax:239-278-0588
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS86662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13433OtherBCBS OF FLORIDA
FL264166600Medicaid
FLP00318169OtherRR MEDICARE FRL
FLP00006639Medicare ID - Type UnspecifiedRR - FL RAD CONSULTANTS
FL264166600Medicaid
FL13433YMedicare ID - Type UnspecifiedFL RAD CONSULTANTS
FL13433OtherBCBS OF FLORIDA
H32677Medicare UPIN
FL13433WMedicare PIN