Provider Demographics
NPI:1053356295
Name:JERYAN, EDWARD M (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:JERYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3345 BURNS RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4324
Mailing Address - Country:US
Mailing Address - Phone:561-622-7661
Mailing Address - Fax:561-622-4651
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:561-622-7661
Practice Address - Fax:561-622-4651
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME00343633OtherLICENSE
FLD21694Medicare UPIN
FL45404Medicare ID - Type Unspecified