Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME0041286 | FL |
NPI | 1003841263 |
---|---|
Provider Name | Dr. Jack A Kravitz |
First Address | Margate, FL 33063 |
Second Address | Margate, FL 33063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049067900 | (05) | FL |
D63248 | (02) |