MEDICARE: DR. GLORIA JACKIE YEE M.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	208200000X	Plastic Surgery Physician	ME86674	FL

General Provider Information

NPI Number	:	1316331721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA JACKIE YEE M.D.

Provider Business Mailing Address
First Line	:	9155 S DADELAND BLVD
Second Line	:	SUITE 1708 PENTHOUSE ONE
City	:	MIAMI
State	:	FL
Zip	:	33156-2737
Country	:	US
Telephone Number	:	305-670-9995
Fax Number	:	305-670-1990

Provider Business Practice Location Address
First Line	:	9155 S DADELAND BLVD
Second Line	:	SUITE 1708 PENTHOUSE ONE
City	:	MIAMI
State	:	FL
Zip	:	33156-2737
Country	:	US
Telephone Number	:	305-670-9995
Fax Number	:	305-670-1990

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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