Provider Demographics
NPI:1225298631
Name:BAHARI-KASHANI, JESSICA N (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:BAHARI-KASHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:N
Other - Last Name:BAHARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7015 A C SKINNER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:7015 A C SKINNER PKWY
Practice Address - Street 2:BUILDING 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6932
Practice Address - Country:US
Practice Address - Phone:904-516-3737
Practice Address - Fax:904-516-3738
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1066372085R0001X
FLME 1120152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL354874OtherAVMED
FL005951700Medicaid
FL14L6DOtherBCBSFL
FLGD458RMedicare PIN
FL005951700Medicaid
FLGD458ZMedicare PIN
FLGD458QMedicare PIN
FL14L6DOtherBCBSFL
FLGD458YMedicare PIN
FLGD458UMedicare PIN
FLGD458VMedicare PIN
FLGD458PMedicare PIN
FLGD458SMedicare PIN
FLGD458XMedicare PIN