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General NPI Number Information
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NPI Number | 1346801024
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Entity Type | Organization
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Legal Business Name | JEAN GERIATRICS, PLLC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 3450 ROWLAND DR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2284
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Country | US
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Telephone | 941-276-8036
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 ROWLAND DR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2284
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Country | US
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Telephone | 941-276-8036
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GERDIE JEAN-SMITH
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Credential | MD
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Telephone | 941-276-8036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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