Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME94306 | FL |
N | 2080A0000X | Adolescent Medicine | ME94306 | FL |
NPI | 1144298498 |
---|---|
Provider Name | Dr. Jeri Anice Dyson |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2006 |
Last Update Date | 01/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2737558-00 | (05) | FL |
765179961A | (05) | GA |
I45883 | (02) | FL |