Provider Demographics
NPI:1164887261
Name:JAKES, BRIAN PETER JR (ND)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PETER
Last Name:JAKES
Suffix:JR
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9755 CORONADO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-5347
Mailing Address - Country:US
Mailing Address - Phone:954-825-3601
Mailing Address - Fax:
Practice Address - Street 1:9755 CORONADO LAKE DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-5347
Practice Address - Country:US
Practice Address - Phone:954-825-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath