Provider Demographics
NPI:1275637589
Name:FRANKLIN, JAY CONRAD (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:CONRAD
Last Name:FRANKLIN
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 1:8525 SW 92ND ST
Mailing Address - Street 2:SUITE D14
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-271-4904
Mailing Address - Fax:305-274-9810
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:SUITE D14
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-271-4904
Practice Address - Fax:305-274-9810
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1521300Medicaid
FL1521300Medicaid