Provider Demographics
NPI:1942415088
Name:DACH, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:DACH
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 1:7450 GRIFFIN RD STE 190
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4123
Mailing Address - Country:US
Mailing Address - Phone:954-792-4663
Mailing Address - Fax:954-792-4575
Practice Address - Street 1:7450 GRIFFIN RD STE 190
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4123
Practice Address - Country:US
Practice Address - Phone:954-792-4663
Practice Address - Fax:954-792-4575
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME364702083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD78836Medicare UPIN