MEDICARE: JAYSHREE V GANATRA M.D.

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	2080P0206X	Pediatric Gastroenterology Physician	ME0082537	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	:	1073554846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYSHREE V GANATRA M.D.

Provider Business Mailing Address
First Line	:	13770 PLANTATION RD STE 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4460
Country	:	US
Telephone Number	:	239-561-6365
Fax Number	:	239-561-6264

Provider Business Practice Location Address
First Line	:	13770 PLANTATION RD
Second Line	:	UNIT 4
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4460
Country	:	US
Telephone Number	:	239-561-6365
Fax Number	:	239-561-6264

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/05/2018

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