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General NPI Number Information
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NPI Number | 1083073092
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Entity Type | Organization
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Legal Business Name | CHIRAG V DESAI MD LLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 9191 R G SKINNER PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9655
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Country | US
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Telephone | 904-955-8434
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Fax |
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Provider Business Mailing Address
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Address Line | 9838 OLD BAYMEADOWS RD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED MEMBER
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Name | DR. CHIRAG V DESAI
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Credential | MD
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Telephone | 904-955-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME 103568
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 103568
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License Number State | FL
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