Basic Information
| Provider Information | |||||||||
| NPI: | 1790784544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEREN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3451 TECHNOLOGICAL AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328178353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073808705 | ||||||||
| FaxNumber: | 4076432804 | ||||||||
| Practice Location | |||||||||
| Address1: | 3451 TECHNOLOGICAL AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328178353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073808705 | ||||||||
| FaxNumber: | 4076432804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME0064807 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | ME0064807 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0106X | ME64807 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 23420 | 01 | FL | BC/BS | OTHER | 373585100 | 05 | FL | MEDICAID | 200030019 | 01 | FL | RAILROAD | OTHER |