MEDICARE: DR. PANKAJ H GANDHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME056092	FL
2	207RI0011X	Interventional Cardiology Physician	ME056092	FL
3	207UN0901X	Nuclear Cardiology Physician	ME056092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134181837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANKAJ H GANDHI MD

Provider Business Mailing Address
First Line	:	2735 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2548
Country	:	US
Telephone Number	:	904-721-0894
Fax Number	:	904-721-0991

Provider Business Practice Location Address
First Line	:	2735 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2548
Country	:	US
Telephone Number	:	904-721-0894
Fax Number	:	904-721-0991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	01/12/2015

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