Provider Demographics
NPI:1457844151
Name:DAVID, JEREL C (MD)
Entity type:Individual
Prefix:DR
First Name:JEREL
Middle Name:C
Last Name:DAVID
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 1:1871 SE TIFFANY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7585
Mailing Address - Country:US
Mailing Address - Phone:772-408-5151
Mailing Address - Fax:772-335-3781
Practice Address - Street 1:1871 SE TIFFANY AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7585
Practice Address - Country:US
Practice Address - Phone:772-363-5566
Practice Address - Fax:772-335-3781
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010030207R00000X
FLME166311207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine