Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 35086921 | OH |
NPI | 1093810574 |
---|---|
Provider Name | Jeremy W Amps |
First Address | Mobile, AL 36608 |
Second Address | Mobile, AL 36608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2679481 | (05) | OH |
515-43364 | BLUE CROSS BLUE SHIELD (01) | AL |
I65772 | (02) | OH |