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NPI Code Detail

MEDICARE: JAYASREE TATAGARI MD

MEDICARE: JAYASREE TATAGARI 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
1207Q00000XFamily Medicine Physician266843NY
2207Q00000XFamily Medicine PhysicianME133465FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932331980
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYASREE TATAGARI MD
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 305-628-6117
Fax Number :
Provider Business Practice Location Address
First Line : 206 N FLORIDA AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33801-4902
Country : US
Telephone Number : 863-209-7003
Fax Number : 863-274-3520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2009
Last Update Date : 10/23/2019

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Directions to “ JAYASREE TATAGARI MD” Practice Location

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