Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME107157 | FL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME107157 | FL |
NPI | 1356517767 |
---|---|
Provider Name | Dr. Jeremy Boyd White |
First Address | Aventura, FL 33180-1232 |
Second Address | Aventura, FL 33180-1232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 23/03/2021 |