Provider Demographics
NPI:1851344493
Name:LEBOW, JEFFREY L (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:LEBOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4426
Mailing Address - Country:US
Mailing Address - Phone:305-947-3700
Mailing Address - Fax:
Practice Address - Street 1:3435 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4426
Practice Address - Country:US
Practice Address - Phone:305-947-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205671200Medicaid
FL205671200Medicaid
FLE32221Medicare UPIN
FL82367ZMedicare ID - Type UnspecifiedPROVIDER #