Basic Information
| Provider Information | |||||||||
| NPI: | 1124082755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OPPENHEIMER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | HARRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7805 NW BEACON SQUARE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334871396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009644395 | ||||||||
| FaxNumber: | 5613256072 | ||||||||
| Practice Location | |||||||||
| Address1: | 7805 NW BEACON SQUARE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334871396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009644395 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 072598 | GA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 301111583 | MI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207T00000X | G55925 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 40508 | MN | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD00046622 | WA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | ME60083 | FL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 246231 | NY | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 042414-L | PA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 25MA05469000 | NJ | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G559250 | 01 | CA | MEDICAL NUMBER | OTHER | 1552089 | 05 | LA | MEDICAID | 290895 | 01 | CA | NMBE | OTHER | BO 0166884 | 01 | LA | DEA | OTHER |