Healthcare Provider Details

I. General information

NPI: 1427479211
Provider Name (Legal Business Name): JBG MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 SE BRIDGE RD
HOBE SOUND FL
33455-5312
US

IV. Provider business mailing address

8925 SE BRIDGE RD
HOBE SOUND FL
33455-5312
US

V. Phone/Fax

Practice location:
  • Phone: 772-245-8397
  • Fax: 772-245-8394
Mailing address:
  • Phone: 772-245-8397
  • Fax: 772-245-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name: ALLISON KERN
Title or Position: OFFICE MANAGER
Credential:
Phone: 772-245-8397