Provider Demographics
NPI:1306841622
Name:JADEJA, JASWANT S (MD)
Entity Type:Individual
Prefix:DR
First Name:JASWANT
Middle Name:S
Last Name:JADEJA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9143 PHILIPS HWY
Mailing Address - Street 2:STE 560
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1369
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:5742 BOOTH RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5905
Practice Address - Country:US
Practice Address - Phone:904-739-7779
Practice Address - Fax:904-739-7771
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 42155207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15184OtherBCBS
FLD52737Medicare UPIN
FL15784AMedicare PIN