Healthcare Provider Details

I. General information

NPI: 1396795977
Provider Name (Legal Business Name): DR. JAKOB ULFARSSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 SEAGRAPE WAY
HOLLYWOOD FL
33019-4865
US

IV. Provider business mailing address

1610 SEAGRAPE WAY
HOLLYWOOD FL
33019-4865
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-2522
  • Fax:
Mailing address:
  • Phone: 954-927-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME44977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: