Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POR142 | FL |
N | 222Z00000X | Podiatrist | POR142 | FL |
Y | 224P00000X | Prosthetist | POR142 | FL |
NPI | 1376744730 |
---|---|
Provider Name | Mr. John Jump |
First Address | Lake Mary, FL 32746-2127 |
Second Address | Lake Mary, FL 32746-2127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 17/08/2021 |