Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME0013668 | FL |
NPI | 1013983964 |
---|---|
Provider Name | Dr. John Jennings |
First Address | Coral Gables, FL 33146-1174 |
Second Address | Coral Gables, FL 33146-1174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D65640 | (02) | FL |