Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3941 | FL |
NPI | 1063861979 |
---|---|
Provider Name | Dr. Kristopher P Jerry |
First Address | Port St Lucie, FL 34952-5545 |
Second Address | Port St Lucie, FL 34952-5545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 24/02/2020 |