Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME96535 | FL |
Y | 207YP0228X | Pediatric Otolaryngology | ME96535 | FL |
NPI | 1356455612 |
---|---|
Provider Name | Dr. Jacob W Zeiders III |
First Address | Fort Lauderdale, FL 33316-2507 |
Second Address | Fort Lauderdale, FL 33316-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 09/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276276500 | (05) | FL |
68319 | BCBS (01) | FL |
ME96535 | MEDICAL LICENSE NUMBER (01) | FL |