Provider Demographics
NPI:1053337733
Name:HORSTMYER, JEFFREY LEE (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:HORSTMYER
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 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-856-8942
Mailing Address - Fax:305-856-0432
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-8942
Practice Address - Fax:305-856-0432
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14410TOtherMEDICARE PTAN