Provider Demographics
NPI:1306811005
Name:COVINGTON, JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:COVINGTON
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 1:3706 N ROOSEVELT BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4566
Mailing Address - Country:US
Mailing Address - Phone:305-517-6613
Mailing Address - Fax:305-517-6614
Practice Address - Street 1:3706 N ROOSEVELT BLVD STE D
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4566
Practice Address - Country:US
Practice Address - Phone:305-517-6613
Practice Address - Fax:305-517-6614
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035477500Medicaid
FL09324TMedicare ID - Type UnspecifiedPRIVATE
FL09324UMedicare ID - Type UnspecifiedMONROE COUNTY HEALTH DEPT
FLE34039Medicare UPIN