Individual
JEFFREY ROBERT ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3871 E HIGHWAY 98 STE 200, PORT ST JOE, FL 32456-5302
(850) 229-5833
(850) 229-5832
Mailing address
4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623
(904) 450-6063
(904) 539-4092
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME159955
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11952742
CAQH PROVIDER ID
CA
Enumeration date
02/06/2008
Last updated
07/19/2023
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