Provider Demographics
NPI:1629054978
Name:ALTOMARE, JEFFRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:D
Last Name:ALTOMARE
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 1:9090 REGENCY SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8119
Mailing Address - Country:US
Mailing Address - Phone:904-855-1335
Mailing Address - Fax:904-724-6515
Practice Address - Street 1:9090 REGENCY SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8119
Practice Address - Country:US
Practice Address - Phone:904-855-1335
Practice Address - Fax:904-724-6515
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E31269Medicare UPIN