MEDICARE: KENNETH S JEFFERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME75879	FL
2	207XP3100X	Pediatric Orthopaedic Surgery Physician	ME75879	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	262501	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467498691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH S JEFFERS MD

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-320-2640
Fax Number	:	954-320-2610

Provider Business Practice Location Address
First Line	:	3100 CORAL HILLS DR STE 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4139
Country	:	US
Telephone Number	:	954-320-2640
Fax Number	:	954-320-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	04/03/2024

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