=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770911174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY S EPSTEIN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2013
-----------------------------------------------------
Last Update Date | 10/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6280 SUNSET DR SUITE 504
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-666-1774
-----------------------------------------------------
Fax | 305-666-6708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6280 SUNSET DR SUITE 504
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-666-1774
-----------------------------------------------------
Fax | 305-666-6708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY S EPSTEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-666-1774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | ME59544
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------