Provider Demographics
NPI:1245073840
Name:JESSICA OKUN, DO LLC
Entity type:Organization
Organization Name:JESSICA OKUN, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-599-5373
Mailing Address - Street 1:301 N GORDON RD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3775
Mailing Address - Country:US
Mailing Address - Phone:954-599-6373
Mailing Address - Fax:
Practice Address - Street 1:1625 SE 3RD AVE STE 415C
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-599-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty