MEDICARE: DR. SANDRA MARITZA JARA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME88282	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003905605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA MARITZA JARA MD

Provider Business Mailing Address
First Line	:	10034 CYPRESS SHADOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1858
Country	:	US
Telephone Number	:	813-994-2486
Fax Number	:

Provider Business Practice Location Address
First Line	:	10034 CYPRESS SHADOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1858
Country	:	US
Telephone Number	:	813-994-2486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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