Provider Demographics
NPI:1073714267
Name:BRAHMBHATT, JAMIN VINOD (MD)
Entity Type:Individual
Prefix:
First Name:JAMIN
Middle Name:VINOD
Last Name:BRAHMBHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 DON WICKHAM DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1978
Mailing Address - Country:US
Mailing Address - Phone:352-536-8761
Mailing Address - Fax:352-536-8768
Practice Address - Street 1:1920 DON WICKHAM DR STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1978
Practice Address - Country:US
Practice Address - Phone:352-536-8761
Practice Address - Fax:352-536-8768
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 112621208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006369500Medicaid