Provider Demographics
NPI:1215927744
Name:CRYAR, JEFFERY RAY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:RAY
Last Name:CRYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 323
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-834-6965
Mailing Address - Fax:407-834-0424
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 323
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-834-6965
Practice Address - Fax:407-834-0424
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL005924208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054249100Medicaid
FL12127ZMedicare ID - Type Unspecified
FL054249100Medicaid