Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME109914 | FL |
Y | 2080P0202X | Pediatric Cardiologist | ME109914 | FL |
N | 2080P0202X | Pediatric Cardiologist | MED-PHYS-LIC-21131 | MT |
NPI | 1093847360 |
---|---|
Provider Name | Dr. Jeremy Michael Archer |
First Address | Gainesville, FL 32610-0297 |
Second Address | Gainesville, FL 32610-0703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 01/09/2020 |