Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME83568 | FL |
NPI | 1821012980 |
---|---|
Provider Name | Dr. Brian S Jewett |
First Address | Miami, FL 33101-6960 |
Second Address | Miami, FL 33101-6960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2619598-00 | (05) | FL |
H19333 | (02) | FL |