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General NPI Number Information
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NPI Number | 1114092806
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Entity Type | Individual
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Provider Name | FERNANDO JARA MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 700 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4924
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Country | US
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Telephone | 727-437-0821
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Fax |
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Provider Business Mailing Address
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Address Line | 10631 VILLAGE LAKE RD
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City | WINDERMERE
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State | FL
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Zip | 34786-5935
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Country | US
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Telephone | 845-721-9458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME83556
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License Number State | FL
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