Provider Demographics
NPI:1366443947
Name:KANER, JEFFREY BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRUCE
Last Name:KANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-961-8400
Mailing Address - Fax:954-961-8401
Practice Address - Street 1:11011 SHERIDAN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-1505
Practice Address - Country:US
Practice Address - Phone:954-961-8400
Practice Address - Fax:954-961-8401
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73251207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254942500Medicaid
FLG83903Medicare UPIN
FLE1676YMedicare ID - Type UnspecifiedMEDICARE NUMBER