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General NPI Number Information
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NPI Number | 1912684572
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Entity Type | Organization
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Legal Business Name | JD GROUP
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 180 DAKOTA AVE APT 57
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City | SANTA CRUZ
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State | CA
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Zip | 95060-6615
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Country | US
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Telephone | 413-330-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 3836 SE DIXIE HWY
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City | STUART
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State | FL
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Zip | 34997-6055
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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 | JOHN DUNN
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Credential |
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Telephone | 413-330-1366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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