MEDICARE: DR. JON FREDRIC HARRELL

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	OS 9033	FL

General Provider Information

NPI Number	:	1992828354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON FREDRIC HARRELL

Provider Business Mailing Address
First Line	:	2770 OAKBROOK LN
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33332-3407
Country	:	US
Telephone Number	:	305-807-6731
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 N COMMERCE PKWY
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3238
Country	:	US
Telephone Number	:	954-384-9692
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	11/29/2010

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