MEDICARE: DR. JASWANT S JADEJA 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	207RH0003X	Hematology & Oncology Physician	ME 42155	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15184	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1306841622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASWANT S JADEJA MD

Provider Business Mailing Address
First Line	:	9143 PHILIPS HWY
Second Line	:	STE 560
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-1369
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-363-2606

Provider Business Practice Location Address
First Line	:	5742 BOOTH RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5905
Country	:	US
Telephone Number	:	904-739-7779
Fax Number	:	904-739-7771

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	10/18/2007

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