Provider Demographics
NPI:1326153701
Name:ZUCKERMAN, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:ZUCKERMAN
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 1:151 CALLE DE SAN FRANCISCO
Mailing Address - Street 2:STE 200, PMB 1036
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901
Mailing Address - Country:US
Mailing Address - Phone:907-388-1003
Mailing Address - Fax:907-802-6625
Practice Address - Street 1:596 CALLE CESAR GONZALEZ APT 1822
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4358
Practice Address - Country:US
Practice Address - Phone:907-388-1003
Practice Address - Fax:907-802-6625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK29542085R0202X
PR0228482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2954Medicaid
AKMD2954Medicaid
00WCGRLEMedicare ID - Type Unspecified