Provider Demographics
NPI:1053491431
Name:AFRICK, JEROME A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:A
Last Name:AFRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:321 MAITLAND AVE
Mailing Address - Street 2:#1500
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-339-4441
Mailing Address - Fax:407-339-6557
Practice Address - Street 1:321 MAITLAND AVE
Practice Address - Street 2:#1500
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-339-4441
Practice Address - Fax:407-339-6557
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME13882207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48741Medicare ID - Type Unspecified
P55425Medicare UPIN