Provider Demographics
NPI:1215043682
Name:RAJA, JAY M (MD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:M
Last Name:RAJA
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 1:900 E PINE ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223
Mailing Address - Country:US
Mailing Address - Phone:941-475-5672
Mailing Address - Fax:941-473-1456
Practice Address - Street 1:900 E PINE ST
Practice Address - Street 2:SUITE 215
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223
Practice Address - Country:US
Practice Address - Phone:941-475-5672
Practice Address - Fax:941-473-1456
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40189207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79827OtherBCBS
D58943Medicare UPIN
FL79827YMedicare ID - Type Unspecified
FL79827OtherBCBS