MEDICARE: DR. JAYENDRA C CHOKSI M.D.

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	2084P0800X	Psychiatry Physician	ME57221	FL

General Provider Information

NPI Number	:	1528058526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYENDRA C CHOKSI M.D.

Provider Business Mailing Address
First Line	:	2630 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1835
Country	:	US
Telephone Number	:	813-930-9310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1835
Country	:	US
Telephone Number	:	813-930-9310
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	02/03/2010

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