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General NPI Number Information
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NPI Number | 1760657407
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Entity Type | Organization
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Legal Business Name | JERRY L. LIKE, D.O.
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 110 W. SYCAMORE ST.
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City | ELBERFELD
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State | IN
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Zip | 47613-0188
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Country | US
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Telephone | 812-983-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 110 W. SYCAMORE P.O. BOX 188
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City | ELBERFELD
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State | IN
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Zip | 47613-0188
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRY L LIKE
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Credential | D.O.
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Telephone | 812-983-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02000254
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License Number State | IN
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