Provider Demographics
NPI:1962403188
Name:SACKS, JEFFREY B (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:SACKS
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 1:3725 11TH CR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4804
Mailing Address - Country:US
Mailing Address - Phone:772-562-0163
Mailing Address - Fax:772-567-5631
Practice Address - Street 1:3725 11TH CR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4804
Practice Address - Country:US
Practice Address - Phone:772-562-0163
Practice Address - Fax:772-567-5631
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME880142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71162OtherBLUE CROSS/BLUE SHIELD
FL267458100Medicaid
FL71162WMedicare PIN
FLH92736Medicare UPIN
FL267458100Medicaid