Healthcare Provider Details

I. General information

NPI: 1700187440
Provider Name (Legal Business Name): JESSICA MACKEY BABCOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST STE 722
MIAMI FL
33175-8101
US

IV. Provider business mailing address

11760 SW 40TH ST STE 722
MIAMI FL
33175-8101
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-1883
  • Fax: 305-559-1887
Mailing address:
  • Phone: 305-559-1883
  • Fax: 305-559-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA147889
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME144928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: