Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME127093 | FL |
NPI | 1043620446 |
---|---|
Provider Name | Henry Jovany Jean |
First Address | Stuart, FL 34994-2364 |
Second Address | Stuart, FL 34994-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2014 |
Last Update Date | 22/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2MTEZ | FLORIDA BLUE (01) | FL |