Provider Demographics
NPI:1780649699
Name:KOREN, JEFFREY R (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:KOREN
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 1:885 SEDALIA STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761
Mailing Address - Country:US
Mailing Address - Phone:407-294-2994
Mailing Address - Fax:407-294-2882
Practice Address - Street 1:885 SEDALIA ST
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3164
Practice Address - Country:US
Practice Address - Phone:407-294-2994
Practice Address - Fax:407-294-2882
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045791400Medicaid