Provider Demographics
NPI:1124082755
Name:OPPENHEIMER, JEFFREY HARRY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HARRY
Last Name:OPPENHEIMER
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 1:7805 NW BEACON SQUARE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1396
Mailing Address - Country:US
Mailing Address - Phone:800-964-4395
Mailing Address - Fax:561-325-6072
Practice Address - Street 1:7805 NW BEACON SQUARE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1396
Practice Address - Country:US
Practice Address - Phone:800-964-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072598207T00000X
MI301111583207T00000X
332B00000X
CAG55925207T00000X
MN40508207T00000X
WAMD00046622207T00000X
FLME60083207T00000X
NY246231207T00000X
PA042414-L207T00000X
NJ25MA05469000207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G559250OtherMEDICAL NUMBER
LA1552089Medicaid
CA290895OtherNMBE
LABO 0166884OtherDEA
CA290895OtherNMBE
CA00G559250OtherMEDICAL NUMBER
LA1552089Medicaid