Provider Demographics
NPI:1346232154
Name:GIFFORD, JEANNE D (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:D
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 HOFFNER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1063
Mailing Address - Country:US
Mailing Address - Phone:407-851-2416
Mailing Address - Fax:
Practice Address - Street 1:22 LAKE BEAUTY DR
Practice Address - Street 2:SUITE 301
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2037
Practice Address - Country:US
Practice Address - Phone:407-423-8756
Practice Address - Fax:407-857-8916
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00106802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55341Medicare UPIN
FL48559Medicare ID - Type Unspecified