MEDICARE: JAMIE L OPPENHEIMER PA-C

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	363A00000X	Physician Assistant	PA9108942	FL

General Provider Information

NPI Number	:	1447770821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE L OPPENHEIMER PA-C

Provider Business Mailing Address
First Line	:	4515 N JEFFERSON AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2937
Country	:	US
Telephone Number	:	786-897-3831
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 N JEFFERSON AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2937
Country	:	US
Telephone Number	:	786-897-3831
Fax Number	:	786-897-3831

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	06/26/2017

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