=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326514167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES J JENNINGS MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2018
-----------------------------------------------------
Last Update Date | 10/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11921 SOUTH DIXIE HWY STE. 201
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-868-0503
-----------------------------------------------------
Fax | 786-524-0956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11921 SOUTH DIXIE HWY STE. 201
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-868-0503
-----------------------------------------------------
Fax | 786-524-0956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | JAMES JOSEPH JENNINGS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-803-1519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------