Provider Demographics
NPI:1245770163
Name:LONGARES, JANE ELPEDES (MD)
Entity type:Individual
Prefix:
First Name:JANE ELPEDES
Middle Name:
Last Name:LONGARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LONGARES
Other - Last Name:EBLACAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7050 W PALMETTO PARK RD STE 15-840
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:561-571-0404
Mailing Address - Fax:561-462-0859
Practice Address - Street 1:7301A W PALMETTO PARK RD STE 306A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3466
Practice Address - Country:US
Practice Address - Phone:561-571-0404
Practice Address - Fax:561-462-0859
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157194207RI0200X
NY307743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine