Individual
JESSICA ELLEN SOUTHWOOD
Active
Individual
JESSICA ELLEN SOUTHWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
45233
AL
207Y00000X
Otolaryngology Physician
61337
WI
207Y00000X
Otolaryngology Physician
A146462
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518223494
—
WI
Enumeration date
04/05/2012
Last updated
12/29/2022
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