=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821251216
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN-PAUL AZZI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2008
-----------------------------------------------------
Last Update Date | 05/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4495 MILITARY TRL STE 202 THE PALM BEACH CENTER FOR FACIAL PLASTIC AND LASER SURG
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-627-6277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8168 SE PILOTS COVE TER
-----------------------------------------------------
City | HOBE SOUND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33455-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-871-1015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YS0123X
-----------------------------------------------------
Taxonomy Name | Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | ME117560
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------