MEDICARE: DR. JERRY MARSHAL LAYNE M.D., D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN1110	FL

General Provider Information

NPI Number	:	1679654644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY MARSHAL LAYNE M.D., D.D.S.

Provider Business Mailing Address
First Line	:	1500 SAN REMO AVE STE 100
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3043
Country	:	US
Telephone Number	:	305-667-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	7231 SW 63RD AVE
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4809
Country	:	US
Telephone Number	:	305-667-1191
Fax Number	:	305-667-2712

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/10/2020

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