MEDICARE: JASURBEK R KADIRBEKOV SA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	13-192	FL

General Provider Information

NPI Number	:	1760842850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASURBEK R KADIRBEKOV SA-C

Provider Business Mailing Address
First Line	:	36 WHITTINGHAM LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-7206
Country	:	US
Telephone Number	:	386-237-2268
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 WHITTINGHAM LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-7206
Country	:	US
Telephone Number	:	386-237-2268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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