Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | C10003098 | DE |
NPI | 1255372140 |
---|---|
Provider Name | Jay D. Luft |
First Address | Wilmington, DE 19806-1392 |
Second Address | Wilmington, DE 19806-1392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 03/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000050801 | (05) | DE |
B66528 | (02) | DE |