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NPI Code Detail

MEDICARE: MAR JAMINAL M.D.

MEDICARE: MAR JAMINAL 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
1207Q00000XFamily Medicine PhysicianME98080FL

Other Identifiers

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

General Provider Information

NPI Number : 1457411100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAR JAMINAL M.D.
Provider Business Mailing Address
First Line : PO BOX 44008
Second Line : UFJP PROVIDER ENROLLMENT
City : JACKSONVILLE
State : FL
Zip : 32231-4008
Country : US
Telephone Number : 904-244-3660
Fax Number : 904-244-3425
Provider Business Practice Location Address
First Line : 1155 E 21ST ST
Second Line : UFJP EASTSIDE FAMILY PRACTICE
City : JACKSONVILLE
State : FL
Zip : 32206-2401
Country : US
Telephone Number : 904-359-9067
Fax Number : 904-360-9651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 02/05/2008

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