Basic Information
| Provider Information | |||||||||
| NPI: | 1164837167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEREMES | ||||||||
| FirstName: | JAROD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BCABA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4891 GLOVER LN | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325704556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506260606 | ||||||||
| FaxNumber: | 8503613443 | ||||||||
| Practice Location | |||||||||
| Address1: | 4891 GLOVER LN | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325704556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506260606 | ||||||||
| FaxNumber: | 8503613443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2014 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | 0-14-6040 | Y |
ID Information
| ID | Type | State | Issuer | Description | 0-14-6040 | 01 | BACB | OTHER |