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General NPI Number Information
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NPI Number | 1366430407
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Entity Type | Individual
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Provider Name | JEFFREY BRUCE NEUSTADT M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 924 MONTEREY PT NE
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City | ST PETERSBURG
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State | FL
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Zip | 33704-2319
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Country | US
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Telephone | 727-656-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 924 MONTEREY PT NE
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City | ST PETERSBURG
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State | FL
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Zip | 33704-2319
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Country | US
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Telephone | 727-656-5410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | ME60369
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME60639
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | ME60369
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License Number State | FL
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