Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME95719 | FL |
N | 208600000X | Surgeon | ME95719 | FL |
N | 2082S0105X | Plastic Hand Surgeon | ME95719 | FL |
N | 2086S0122X | Plastic and Reconstructive Surgery | 036-103717 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | 47912 | WI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME95719 | FL |
NPI | 1710041231 |
---|---|
Provider Name | Dr. Jacob Gerzenshtein |
First Address | Lakeland, FL 33813-1516 |
Second Address | Lakeland, FL 33813-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H93964 | (02) |