Individual
JERRY TAVORNWATTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
655 W 8TH ST # C506, JACKSONVILLE, FL 32209-6511
(904) 244-3817
Mailing address
655 W 8TH ST # C506, JACKSONVILLE, FL 32209-6511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME140761
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2016
Last updated
06/05/2019
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