Healthcare Provider Details

I. General information

NPI: 1467409037
Provider Name (Legal Business Name): MEENAKSHI JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEENA JAIN MD

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 66TH ST N SUITE 7
ST PETERSBURG FL
33710-1569
US

IV. Provider business mailing address

PO BOX 14657
CLEARWATER FL
33766-4657
US

V. Phone/Fax

Practice location:
  • Phone: 727-343-2568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0043246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: