Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301104804 | MI |
Y | 111NI0900X | Internist | 4301104804 | MI |
NPI | 1003216359 |
---|---|
Provider Name | Jerry Xavier |
First Address | Saginaw, MI 48602-5303 |
Second Address | Saginaw, MI 48602-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2014 |
Last Update Date | 23/08/2014 |