Provider Demographics
NPI:1669441705
Name:LOMBARD, JEFFREY S (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:LOMBARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2039 INDIAN ROCKS RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1035
Mailing Address - Country:US
Mailing Address - Phone:727-596-9652
Mailing Address - Fax:727-593-5128
Practice Address - Street 1:2039 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1035
Practice Address - Country:US
Practice Address - Phone:727-596-9652
Practice Address - Fax:727-593-5128
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004266208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS0004286OtherSTATE LICENSE
FL066224100Medicaid
FL82864UMedicare ID - Type Unspecified
FLD60750Medicare UPIN