Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME142761 | FL |
Y | 208600000X | Surgeon | ME142761 | FL |
N | 2086X0206X | Surgical Oncologist | 079673 | GA |
NPI | 1285078436 |
---|---|
Provider Name | Dr. Jeremy Richard John |
First Address | Celebration, FL 34747-4606 |
Second Address | Celebration, FL 34747-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2013 |
Last Update Date | 13/12/2019 |