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General NPI Number Information
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NPI Number | 1457635773
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Entity Type | Organization
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Legal Business Name | JPMMH ENTERPRISES OF VERO BEACH, LLC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 777 37TH ST SUITE B-107
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-226-5026
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Fax | 772-226-7682
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Provider Business Mailing Address
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Address Line | 777 37TH ST SUITE B-107
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-226-5026
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Fax | 772-226-7682
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. LARRY JAMES
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Credential | P.A.-C
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Telephone | 772-226-5026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101301
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License Number State | FL
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