Healthcare Provider Details

I. General information

NPI: 1467498691
Provider Name (Legal Business Name): KENNETH S JEFFERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CORAL HILLS DR STE 202
CORAL SPRINGS FL
33065-4139
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-320-2640
  • Fax: 954-320-2610
Mailing address:
  • Phone: 954-320-2640
  • Fax: 954-320-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME75879
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME75879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: