Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN9446 | FL |
NPI | 1053317842 |
---|---|
Provider Name | Dr. Jack Jacob Hirschfeld |
First Address | Palm Springs, FL 33406-7616 |
Second Address | Palm Springs, FL 33406-7616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T54868FL | (02) | FL |