Provider Demographics
NPI:1376562553
Name:REDAN, JAY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:REDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CELEBRATION PL
Mailing Address - Street 2:SUITE A-140
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4970
Mailing Address - Country:US
Mailing Address - Phone:407-303-4602
Mailing Address - Fax:407-303-4603
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:SUITE A-140
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-4602
Practice Address - Fax:407-303-4603
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89458208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269094200Medicaid
FL37613OtherBCBS
P00149683OtherRAILROAD MEDICARE
FL269094200Medicaid
FL37613OtherBCBS