Healthcare Provider Details

I. General information

NPI: 1407092562
Provider Name (Legal Business Name): VISHESH PURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6885 BELFORT OAKS PL STE 230
JACKSONVILLE FL
32216-6283
US

IV. Provider business mailing address

12620 BEACH BLVD STE 3-422
JACKSONVILLE FL
32246-7131
US

V. Phone/Fax

Practice location:
  • Phone: 904-593-5333
  • Fax: 904-593-5334
Mailing address:
  • Phone: 904-593-5333
  • Fax: 904-593-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME161507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: