Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME-23668 | FL |
NPI | 1477579944 |
---|---|
Provider Name | Dr. Jimmy E. Jones |
First Address | Atlanta, GA 30384-0001 |
Second Address | Pensacola, FL 32504-8785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00123776 | (05) | MS |
009705430 | (05) | AL |
01470155 | (05) | LA |
050697400 | (05) | FL |
D53201 | (02) |