Provider Demographics
NPI:1124091202
Name:LERNER, KEITH JAY (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAY
Last Name:LERNER
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 1:4850 W OAKLAND PK BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7261
Mailing Address - Country:US
Mailing Address - Phone:954-484-4440
Mailing Address - Fax:954-484-9250
Practice Address - Street 1:4850 W OAKLAND PK BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7261
Practice Address - Country:US
Practice Address - Phone:954-484-4440
Practice Address - Fax:954-484-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0050779207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02551Medicare UPIN
FL03947Medicare ID - Type Unspecified