Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 038563 | FL |
NPI | 1083836993 |
---|---|
Provider Name | Dr. Diane Louise Jeffery |
First Address | Sun City Center, FL 33573-5253 |
Second Address | Sun City Center, FL 33573-5253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D53965 | (02) | FL |