Healthcare Provider Details

I. General information

NPI: 1558396721
Provider Name (Legal Business Name): BONE & JOINT INSTITUTE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FORT ST SUITE 100
PORT HURON MI
48060-3941
US

IV. Provider business mailing address

600 FORT ST SUITE 100
PORT HURON MI
48060-3941
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9871
  • Fax: 810-987-6070
Mailing address:
  • Phone: 810-987-9871
  • Fax: 810-987-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301050081
License Number StateMI

VIII. Authorized Official

Name: DR. GERALD J JERRY JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 810-987-9871