Provider Demographics
NPI:1427547264
Name:LLAMAS, JEWEL CARESSE (MD)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:CARESSE
Last Name:LLAMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MANNING DR # 7595
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7595
Mailing Address - Country:US
Mailing Address - Phone:984-974-4544
Mailing Address - Fax:919-966-6125
Practice Address - Street 1:590 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6119
Practice Address - Country:US
Practice Address - Phone:984-974-4544
Practice Address - Fax:919-966-6125
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-02360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA