Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000688A | IN |
Y | 222Z00000X | Podiatrist | 07000688A | IN |
NPI | 1033170865 |
---|---|
Provider Name | Dr. Berle Jones |
First Address | Tuscaloosa, AL 35404-5015 |
Second Address | Tuscaloosa, AL 35404-5015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 12/12/2011 |