Healthcare Provider Details

I. General information

NPI: 1487713483
Provider Name (Legal Business Name): JEFFREY EDWARD POILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E PAR ST
ORLANDO FL
32804-4004
US

IV. Provider business mailing address

324 E PAR ST
ORLANDO FL
32804
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-8861
  • Fax: 407-895-5347
Mailing address:
  • Phone: 407-896-8861
  • Fax: 407-895-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME0012416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: