MEDICARE: DR. BRIAN PETER JAKES JR. N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath

General Provider Information

NPI Number	:	1164887261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PETER JAKES JR. N.D.

Provider Business Mailing Address
First Line	:	9755 CORONADO LAKE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-5347
Country	:	US
Telephone Number	:	954-825-3601
Fax Number	:

Provider Business Practice Location Address
First Line	:	9755 CORONADO LAKE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-5347
Country	:	US
Telephone Number	:	954-825-3601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/16/2015

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