Provider Demographics
NPI:1346287372
Name:TRANTALIS, JEFFREY JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:TRANTALIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SE 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7437
Mailing Address - Country:US
Mailing Address - Phone:954-418-6980
Mailing Address - Fax:954-596-8132
Practice Address - Street 1:15300 JOG ROAD
Practice Address - Street 2:SUITE 107/108
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2164
Practice Address - Country:US
Practice Address - Phone:561-742-5959
Practice Address - Fax:561-734-2226
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2685213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT01874Medicare UPIN
FL65864XMedicare PIN