Provider Demographics
NPI:1528194586
Name:ROCKEFELLER, JEFFREY J (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:ROCKEFELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MAINSAIL CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-1404
Mailing Address - Country:US
Mailing Address - Phone:561-818-8512
Mailing Address - Fax:
Practice Address - Street 1:401 MAINSAIL CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-1404
Practice Address - Country:US
Practice Address - Phone:561-818-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1518213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041392500Medicaid
FLT88556Medicare UPIN
FL87833AMedicare ID - Type Unspecified