MEDICARE: JAYANTH G RAO 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	2085R0001X	Radiation Oncology Physician	ME 65465	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00909691	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25903	OTHER	FL	BCBS OF FL
2	103495	OTHER	FL	AVMED
3	25903	OTHER	FL	BCBS
4	P00056	OTHER	FL	FREEDOM HEALTH
6	P01254190	OTHER	FL	RAILROAD MCR
7	P201226	OTHER	FL	OPTIMUM
8	2486569	OTHER	FL	CIGNA
9	5002104	OTHER	FL	AETNA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	937635	OTHER	FL	WELLCARE

General Provider Information

NPI Number	:	1528053162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYANTH G RAO M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	3406 N LECANTO HWY.
Second Line	:	SUITE A
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3548
Country	:	US
Telephone Number	:	352-746-1100
Fax Number	:	352-422-7023

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	05/13/2016

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