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General NPI Number Information
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NPI Number | 1548591076
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Entity Type | Organization
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Legal Business Name | NOBLEJAZZ, INC
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 3320 THOMASVILLE RD STE 302
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7971
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Country | US
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Telephone | 775-842-2903
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 THOMASVILLE RD STE 302
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7971
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Country | US
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Telephone | 775-842-2903
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | WESLEY BLAKE VANDERLAN
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Credential | MD
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Telephone | 775-842-2903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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