=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578539995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANISH RELAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2006
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9191 R G SKINNER PKWY UNIT 603
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-9661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-503-6999
-----------------------------------------------------
Fax | 904-503-6998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9838 OLD BAYMEADOWS RD # 344
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-8101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-503-6999
-----------------------------------------------------
Fax | 904-503-6998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME91096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | ME91096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------