Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 50736 | MA |
NPI | 1225010440 |
---|---|
Provider Name | Louis M Jurist |
First Address | Waltham, MA 02451-1906 |
Second Address | Framingham, MA 01701-5224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050736 | TUFTS (01) | MA |
17459 | HPHC (01) | MA |
2097222 | (05) | MA |
A53571 | (02) | |
J01045 | BCBS (01) | MA |