Healthcare Provider Details

I. General information

NPI: 1093828014
Provider Name (Legal Business Name): DAVID JEZYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 GRIFFIN DR
WILMINGTON DE
19808-4254
US

IV. Provider business mailing address

4515 GRIFFIN DR
WILMINGTON DE
19808-4254
US

V. Phone/Fax

Practice location:
  • Phone: 302-999-7364
  • Fax: 302-424-9362
Mailing address:
  • Phone: 302-999-7364
  • Fax: 302-424-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCI-0D00967
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: