1215975503 NPI number — JONATHAN S APPELBAUM M.D.

Table of content: JONATHAN S APPELBAUM M.D. (NPI 1215975503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215975503 NPI number — JONATHAN S APPELBAUM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
APPELBAUM
Provider First Name:
JONATHAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215975503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
Provider Second Line Business Mailing Address:
1115 WEST CALL STREET, SUITE 3140-J
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32306-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-645-1227
Provider Business Mailing Address Fax Number:
850-644-0158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
JEFFERSON COUNTY HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32344-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-342-0170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  96766 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000858900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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