Provider Demographics
NPI:1538159074
Name:DEJONG, EVERETT SCHUYLER (MD)
Entity type:Individual
Prefix:
First Name:EVERETT
Middle Name:SCHUYLER
Last Name:DEJONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EVERETT
Other - Middle Name:S
Other - Last Name:DEJONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5624
Mailing Address - Fax:
Practice Address - Street 1:205 E NASA BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1950
Practice Address - Country:US
Practice Address - Phone:321-361-5624
Practice Address - Fax:321-728-8649
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77782207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79765YOtherMEDICARE
FL268183800Medicaid
FL79765ZMedicare PIN