MEDICARE: DR. GARRY S KITAY 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	207X00000X	Orthopaedic Surgery Physician	ME70885	FL
2	207XS0106X	Orthopaedic Hand Surgery Physician	ME70885	FL
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME70885	FL
4	2086S0105X	Surgery of the Hand (Surgery) Physician	ME70885	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	:	1265436034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRY S KITAY M.D.

Provider Business Mailing Address
First Line	:	1325 SAN MARCO BLVD STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8566
Country	:	US
Telephone Number	:	904-346-3465
Fax Number	:	904-858-6489

Provider Business Practice Location Address
First Line	:	1325 SAN MARCO BLVD STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8566
Country	:	US
Telephone Number	:	904-346-3465
Fax Number	:	904-396-0388

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/16/2020

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Directions to “ DR. GARRY S KITAY M.D.” Practice Location

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