Healthcare Provider Details

I. General information

NPI: 1730199316
Provider Name (Legal Business Name): JAY D HASKETT D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 37TH PL
VERO BEACH FL
32960-6541
US

IV. Provider business mailing address

827 18TH ST
VERO BEACH FL
32960-6481
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-5785
  • Fax: 772-257-5325
Mailing address:
  • Phone: 772-925-8190
  • Fax: 772-925-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME41252
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME41252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: