1548262330 NPI number — DR. JERRILYN M JUTTON MD

Table of content: DR. JERRILYN M JUTTON MD (NPI 1548262330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548262330 NPI number — DR. JERRILYN M JUTTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUTTON
Provider First Name:
JERRILYN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1548262330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 LUBRANO DR
Provider Second Line Business Mailing Address:
SUITE L-101
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-224-7449
Provider Business Mailing Address Fax Number:
410-626-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 SW 160TH AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33027-6308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-866-7123
Provider Business Practice Location Address Fax Number:
855-855-2792
Provider Enumeration Date:
08/11/2005

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: 208600000X , with the licence number:  D38829 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: D38829 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 354900 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3962433 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5484285 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 609963600 . This is a "FEDERAL WORKMAN'S COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42543903 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 224963 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".




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