Provider Demographics
NPI:1902834591
Name:LEFFERTS, JACKIE KLEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:KLEIN
Last Name:LEFFERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 DUCK AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4427
Mailing Address - Country:US
Mailing Address - Phone:305-294-1024
Mailing Address - Fax:305-296-2444
Practice Address - Street 1:3412 DUCK AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4427
Practice Address - Country:US
Practice Address - Phone:305-294-1024
Practice Address - Fax:305-296-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52886207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053624500Medicaid
FL12339Medicare ID - Type Unspecified
FL053624500Medicaid