MEDICARE: DR. ROHAN ANIL DIAL 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	208000000X	Pediatrics Physician	ME73857	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	:	1588615439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROHAN ANIL DIAL MD

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	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2401
Country	:	US
Telephone Number	:	904-359-9696
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/03/2007

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