Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN 15360 | FL |
NPI | 1033318688 |
---|---|
Provider Name | Dr. Jeremy Matthew Albert |
First Address | New Port Richey, FL 34655-5652 |
Second Address | New Port Richey, FL 34655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |