Provider Demographics
NPI:1184673444
Name:PURI, JAIDEEP (MD)
Entity Type:Individual
Prefix:
First Name:JAIDEEP
Middle Name:
Last Name:PURI
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 1:221 GREENWICH CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2890
Mailing Address - Country:US
Mailing Address - Phone:561-694-1021
Mailing Address - Fax:561-694-1908
Practice Address - Street 1:221 GREENWICH CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2890
Practice Address - Country:US
Practice Address - Phone:561-694-1021
Practice Address - Fax:561-694-1908
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104591207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64043672Medicaid
KY0694303Medicare ID - Type Unspecified
KY64043672Medicaid