Healthcare Provider Details

I. General information

NPI: 1598848491
Provider Name (Legal Business Name): DEBORAH ANN JONES D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE 19TH ST
FORT LAUDERDALE FL
33316-2840
US

IV. Provider business mailing address

300 SE 19TH ST
FORT LAUDERDALE FL
33316-2840
US

V. Phone/Fax

Practice location:
  • Phone: 954-662-3668
  • Fax: 954-779-7445
Mailing address:
  • Phone: 954-662-3668
  • Fax: 954-779-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: