MEDICARE: DR. SUPARNA JAIN 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	207R00000X	Internal Medicine Physician	E3946	AR
2	207R00000X	Internal Medicine Physician	ME97369	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649240839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUPARNA JAIN MD

Provider Business Mailing Address
First Line	:	4745 SUTTON PARK COURT
Second Line	:	SUITE 701
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0257
Country	:	US
Telephone Number	:	904-821-0405
Fax Number	:	904-821-0468

Provider Business Practice Location Address
First Line	:	4745 SUTTON PARK COURT
Second Line	:	SUITE 701
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0257
Country	:	US
Telephone Number	:	904-821-0405
Fax Number	:	904-821-0468

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/03/2014

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