MEDICARE: DR. BHARAT K MISRA 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	ME73310	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	:	1194717116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHARAT K MISRA MD

Provider Business Mailing Address
First Line	:	4800 BELFORT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6004
Country	:	US
Telephone Number	:	904-398-3262
Fax Number	:	904-265-4807

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:	SUITE 705
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4230
Country	:	US
Telephone Number	:	904-398-6718
Fax Number	:	904-396-0329

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	05/24/2011

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