Individual
JERRY WIMBERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12110 NE MIAMI CT, NORTH MIAMI, FL 33161-5354
(305) 685-3796
Mailing address
12110 NE MIAMI CT, NORTH MIAMI, FL 33161-5354
(305) 685-3796
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
FL
Other
Enumeration date
03/27/2008
Last updated
03/27/2008
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