Provider Demographics
NPI:1366637951
Name:DR WENTWORTH JARRETT PA
Entity Type:Organization
Organization Name:DR WENTWORTH JARRETT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENTWORTH
Authorized Official - Middle Name:G
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-520-5750
Mailing Address - Street 1:12955 SW 132ND ST
Mailing Address - Street 2:BLDG 3B SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7205
Mailing Address - Country:US
Mailing Address - Phone:305-520-5750
Mailing Address - Fax:305-520-5754
Practice Address - Street 1:12955 SW 132ND ST
Practice Address - Street 2:BLDG 3B SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7205
Practice Address - Country:US
Practice Address - Phone:305-520-5750
Practice Address - Fax:305-520-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20890OtherUPIN
FL046128800Medicaid
FL04162OtherBC/BS
PENDINGMedicare PIN