Provider Demographics
NPI:1023384179
Name:PERSAUD, RAJESH ARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:ARUN
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1851 OLD MOULTRIE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4167
Mailing Address - Country:US
Mailing Address - Phone:904-824-8088
Mailing Address - Fax:904-826-4105
Practice Address - Street 1:1851 OLD MOULTRIE RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4167
Practice Address - Country:US
Practice Address - Phone:904-824-8088
Practice Address - Fax:904-826-4105
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice