MEDICARE: DR. JAIS MEERA EMMANUEL VALLEY 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	ME168446	FL
2	208000000X	Pediatrics Physician	MD210002068	DC

General Provider Information

NPI Number	:	1851852420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIS MEERA EMMANUEL VALLEY MD

Provider Business Mailing Address
First Line	:	6325 US HIGHWAY 27 N STE 201
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-8226
Country	:	US
Telephone Number	:	863-382-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6325 US HIGHWAY 27 N STE 201
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-8226
Country	:	US
Telephone Number	:	863-382-9600
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	11/04/2024

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