Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD-36734 | IA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 277090 | MA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD-36734 | IA |
NPI | 1316043565 |
---|---|
Provider Name | Jean Jaoude |
First Address | Springfield, MA 01199-1001 |
Second Address | West Springfield, MA 01089-1359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 17/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I61936 | (02) | IA |