Healthcare Provider Details

I. General information

NPI: 1316268469
Provider Name (Legal Business Name): HIREN JAGDISH JOSHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 JACLIF CT
TALLAHASSEE FL
32308-4430
US

IV. Provider business mailing address

1845 JACLIF CT
TALLAHASSEE FL
32308-4430
US

V. Phone/Fax

Practice location:
  • Phone: 850-999-2328
  • Fax: 850-320-6114
Mailing address:
  • Phone: 850-999-2328
  • Fax: 850-320-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME113752
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: