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General NPI Number Information
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NPI Number | 1306069562
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Entity Type | Individual
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Provider Name | GAURAV TANDON MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 6885 BELFORT OAKS PL STE 230
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6283
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Country | US
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Telephone | 904-593-5333
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Fax | 904-593-5334
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Provider Business Mailing Address
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Address Line | 12620 BEACH BLVD STE 3-422
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7131
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Country | US
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Telephone | 623-734-5400
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-097593
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 125049759
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01066629
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME121997
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License Number State | FL
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