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General NPI Number Information
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NPI Number | 1295986891
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Entity Type | Organization
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Legal Business Name | CANADY & JAGDEO PHYSICIAN ASSOCIATES P L
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 1645 LAKELAND HILLS BLVD SUITE 4
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City | LAKELAND
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State | FL
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Zip | 33805-3025
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Country | US
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Telephone | 412-508-4831
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 LAKELAND HILLS BLVD SUITE 4
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City | LAKELAND
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State | FL
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Zip | 33805-3025
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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 | PRESIDENT
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Name | JEROME CANADY
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Credential |
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Telephone | 412-508-4831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME102632
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License Number State | FL
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