Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME13882 | FL |
NPI | 1053491431 |
---|---|
Provider Name | Dr. Jerome A Africk |
First Address | Altamonte Springs, FL 32701 |
Second Address | Altamonte Springs, FL 32701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P55425 | (02) |