Provider Demographics
NPI:1710946124
Name:LAUER, JEFFREY TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TAYLOR
Last Name:LAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE #900
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4753
Mailing Address - Country:US
Mailing Address - Phone:904-381-9651
Mailing Address - Fax:904-389-9319
Practice Address - Street 1:515 W 6TH ST
Practice Address - Street 2:MC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4324
Practice Address - Country:US
Practice Address - Phone:904-253-1040
Practice Address - Fax:904-253-1990
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75220207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110198855OtherRAILROAD MEDICARE
FL2573865-00Medicaid
GA000843334AMedicaid
FLH03496Medicare UPIN
FLE3059ZMedicare PIN