Provider Demographics
NPI:1386639508
Name:CANTOR, JEFFREY BRIAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRIAN
Last Name:CANTOR
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 1:3000 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1772
Mailing Address - Country:US
Mailing Address - Phone:954-567-1332
Mailing Address - Fax:954-537-7705
Practice Address - Street 1:3000 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1772
Practice Address - Country:US
Practice Address - Phone:954-567-1332
Practice Address - Fax:954-537-7705
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63802Medicare UPIN
FL23101Medicare ID - Type Unspecified