Individual
JAY DE VERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
417 W ELIZABETH ST APT A, CLINTON, NC 28328-4465
(443) 562-7065
Mailing address
417 W ELIZABETH ST APT A, CLINTON, NC 28328-4465
(443) 562-7065
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
P12962
NC
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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