Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 39380 | AL |
NPI | 1013370832 |
---|---|
Provider Name | Jeffrey St. John |
First Address | Mobile, AL 36606-2443 |
Second Address | Mobile, AL 36695-4617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 11/06/2020 |