Provider Demographics
NPI:1164458758
Name:PANCHAL, JAYANTI J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTI
Middle Name:J
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2654 SW 32ND PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7847
Mailing Address - Country:US
Mailing Address - Phone:352-854-7444
Mailing Address - Fax:352-873-6647
Practice Address - Street 1:2654 SW 32ND PL
Practice Address - Street 2:100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7847
Practice Address - Country:US
Practice Address - Phone:352-854-7444
Practice Address - Fax:352-873-6647
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376187800Medicaid
FL110137564OtherRAILROAD MEDICARE
FL25355OtherBCBS
FL25355ZMedicare PIN
FL376187800Medicaid