Provider Demographics
NPI:1669636528
Name:KENNETH JEFFERS, MD, PA
Entity Type:Organization
Organization Name:KENNETH JEFFERS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-296-2345
Mailing Address - Street 1:12983 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9207
Mailing Address - Country:US
Mailing Address - Phone:561-296-2345
Mailing Address - Fax:561-296-2346
Practice Address - Street 1:12983 SOUTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9207
Practice Address - Country:US
Practice Address - Phone:561-296-2345
Practice Address - Fax:561-296-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75879207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty