Individual
MR. MYLES SIDNEY JERDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL DOCTOR
Contact information
Practice address
1605 WHITESVILLE ST, LAGRANGE, GA 30240-5903
(877) 231-3376
(850) 522-8354
Mailing address
2505 HARRISON AVE, PANAMA CITY, FL 32405-4464
(850) 233-3376
(850) 522-8354
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
30796
GA
207N00000X
Dermatology Physician
60136
TN
207N00000X
Dermatology Physician
D30796
GA
207ND0900X
Dermatopathology Physician
030796
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q053605
—
TN
Enumeration date
04/26/2006
Last updated
08/28/2020
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