Healthcare Provider Details

I. General information

NPI: 1548262330
Provider Name (Legal Business Name): JERRILYN M JUTTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE 250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

129 LUBRANO DR SUITE L-101
ANNAPOLIS MD
21401-7564
US

V. Phone/Fax

Practice location:
  • Phone: 877-866-7123
  • Fax: 855-855-2792
Mailing address:
  • Phone: 410-224-7449
  • Fax: 410-626-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD38829
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD38829
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: