Provider Demographics
NPI:1013988658
Name:KARR, JEFFREY C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:KARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-646-5960
Mailing Address - Fax:863-644-2847
Practice Address - Street 1:5421 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-646-5960
Practice Address - Fax:863-644-2847
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212764OtherAMERIGROUP
FL01369OtherUNIVERSAL
FL2560434OtherAETNA
FLU65457Medicare UPIN
FL65500Medicare PIN
FL65500Medicare ID - Type Unspecified