Provider Demographics
NPI:1609918804
Name:JEFFREY L HORSTMYER MD PA
Entity Type:Organization
Organization Name:JEFFREY L HORSTMYER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORSTMYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-8942
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-856-8942
Mailing Address - Fax:305-854-4028
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-8942
Practice Address - Fax:305-854-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33029AOtherMEDICARE PTAN