Provider Demographics
NPI:1255333118
Name:SINGH, JAI P (MD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:P
Last Name:SINGH
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 1:201 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3631
Mailing Address - Country:US
Mailing Address - Phone:618-549-0721
Mailing Address - Fax:618-351-4919
Practice Address - Street 1:35 ALBANY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-7605
Practice Address - Country:US
Practice Address - Phone:618-457-5111
Practice Address - Fax:618-457-6560
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92716207L00000X
IL036085146207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085146Medicaid
FL272427800Medicaid
FL03401OtherBLUECROSS & BLUESHIELD
FLN135OtherHEALTH FIRST NETWORK
IL036085146OtherIL BLUE CROSS/BLUE SHIELD
AL59178178OtherBLUECROSS & BLUESHIELD
AL009992645Medicaid