Provider Demographics
NPI:1326066051
Name:REINERTSEN, JEFFERY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SCOTT
Last Name:REINERTSEN
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 1:809 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3255
Mailing Address - Country:US
Mailing Address - Phone:386-734-1824
Mailing Address - Fax:386-738-7497
Practice Address - Street 1:809 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3255
Practice Address - Country:US
Practice Address - Phone:386-734-1824
Practice Address - Fax:386-738-7497
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11390OtherBLUE CROSS
FL4217186OtherAETNA
FL0057770OtherME#
FL624OtherFHC
FL624OtherFHC
FLBR2310047OtherDEA