Provider Demographics
NPI:1821103789
Name:LASKOFF, JEFFREY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:LASKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:MICHAEL
Other - Last Name:LASKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:1502 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2017
Mailing Address - Country:US
Mailing Address - Phone:407-841-3620
Mailing Address - Fax:407-843-8423
Practice Address - Street 1:1502 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2017
Practice Address - Country:US
Practice Address - Phone:407-841-3620
Practice Address - Fax:407-843-8423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056568700Medicaid
D58184Medicare UPIN
FL056568700Medicaid