Provider Demographics
NPI:1407885692
Name:JEYABARATH, VINAITHEERTHA PERUMAL (MD)
Entity Type:Individual
Prefix:MR
First Name:VINAITHEERTHA
Middle Name:PERUMAL
Last Name:JEYABARATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6350
Mailing Address - Fax:239-343-4738
Practice Address - Street 1:9800 S HEALTHPARK DR STE 320
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3630
Practice Address - Country:US
Practice Address - Phone:239-343-6350
Practice Address - Fax:239-343-4738
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82878207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7852254OtherAETNA
FLP11162038OtherMULTIPLAN
FL2098464OtherFIRST HEALTH
0194054OtherGHI
FLP00664878OtherRAILROAD MCR
FL288011OtherAV MED
FL101902000Medicaid
FL57738OtherBLUE CROSS BLUE SHIELD
FL215868OtherSTAYWELL AND WELLCARE
FLH42124Medicare UPIN