Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | JM048598 | MI |
N | 207ND0101X | MOHS-Micrographic Surgeon | JM048598 | MI |
N | 207ND0900X | Dermatopathologist | JM048598 | MI |
N | 207NP0225X | Pediatric Dermatologist | JM048598 | MI |
N | 207NS0135X | Procedural Dermatology | JM048598 | MI |
NPI | 1699724302 |
---|---|
Provider Name | Jeffrey Leonard Messenger |
First Address | Durand, MI 48429-1083 |
Second Address | Durand, MI 48429-1083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 28/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03 00013 | PHP OF MICHIGAN (01) | MI |
1664892 | (05) | MI |
A78177 | (02) | MI |
AM2623735 | DEA (01) | MI |
JM048598 | STATE LICENSE (01) | MI |