Provider Demographics
NPI:1093813669
Name:ROSENFIELD, JEFFREY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:ROSENFIELD
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 1:13030 LIVINGSTON ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105
Mailing Address - Country:US
Mailing Address - Phone:239-403-3772
Mailing Address - Fax:239-403-3770
Practice Address - Street 1:13030 LIVINGSTON ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105
Practice Address - Country:US
Practice Address - Phone:239-403-3772
Practice Address - Fax:239-403-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53433207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010065837OtherRAILROAD MEDICARE
FL372225200Medicaid
FL11963OtherBLUE CROSS OF FLORIDA
FLA82934Medicare UPIN
FL11963YMedicare ID - Type Unspecified