Provider Demographics
NPI:1619079662
Name:DEUKMEDJIAN, ARA JASON (MD)
Entity Type:Individual
Prefix:
First Name:ARA
Middle Name:JASON
Last Name:DEUKMEDJIAN
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 1:7955 SPYGLASS HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8249
Mailing Address - Country:US
Mailing Address - Phone:321-255-6670
Mailing Address - Fax:321-242-2545
Practice Address - Street 1:7955 SPYGLASS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8249
Practice Address - Country:US
Practice Address - Phone:321-255-6670
Practice Address - Fax:321-242-2545
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82061207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37913OtherBLUE CROSS BLUE SHIELD
FL611936100OtherDEPT OF LABOR (WC)
FL269771800Medicaid
FL2921108001OtherCIGNA
FL7505598OtherAETNA
FL3612958OtherAETNA HMO
FLP00141641OtherMEDICARD RAILROAD
FL37913OtherBLUE CROSS BLUE SHIELD
FL3612958OtherAETNA HMO
I09579Medicare UPIN