Provider Demographics
NPI:1437251386
Name:GAJERA, JAYANT C (MD)
Entity Type:Individual
Prefix:
First Name:JAYANT
Middle Name:C
Last Name:GAJERA
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 1:14801 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2844
Mailing Address - Country:US
Mailing Address - Phone:813-971-4400
Mailing Address - Fax:813-971-1207
Practice Address - Street 1:14801 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2844
Practice Address - Country:US
Practice Address - Phone:813-971-4400
Practice Address - Fax:813-971-1207
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061918300Medicaid
B42361Medicare UPIN
04571YMedicare ID - Type Unspecified