Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME118990 | FL |
NPI | 1467541557 |
---|---|
Provider Name | Jill Suzanne Whitehouse |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011813800 | (05) | FL |