Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D4300 | AZ |
Y | 204E00000X | Oral & Maxillofacial Surgeon | D4300 | AZ |
NPI | 1063498608 |
---|---|
Provider Name | Dr. Jerome Scott Holbrook |
First Address | Tuscon, AZ 85715 |
Second Address | Tuscon, AZ 85715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 25/09/2020 |