Provider Demographics
NPI:1790784544
Name:DEREN, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:DEREN
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 1:3451 TECHNOLOGICAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8353
Mailing Address - Country:US
Mailing Address - Phone:407-380-8705
Mailing Address - Fax:407-643-2804
Practice Address - Street 1:3451 TECHNOLOGICAL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8353
Practice Address - Country:US
Practice Address - Phone:407-380-8705
Practice Address - Fax:407-643-2804
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064807207X00000X, 207XS0106X
FLME64807207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23420OtherBC/BS
FL373585100Medicaid
FL200030019OtherRAILROAD
FL373585100Medicaid
FL23420ZMedicare PIN