Provider Demographics
NPI:1700989688
Name:HERRING, JEFFERSON D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:D
Last Name:HERRING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4105 PRIMARY PEMBROKE ROAD
Mailing Address - Street 2:MEMORIAL PRIMARY CARE CENTER
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-987-1551
Mailing Address - Fax:954-752-8214
Practice Address - Street 1:4015 PRIMARY PEMBROKE ROAD
Practice Address - Street 2:MEMORIAL PRIMARY CARE CENTER
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-987-1551
Practice Address - Fax:954-752-8214
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME84985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH48290Medicare UPIN