Provider Demographics
NPI:1457319741
Name:KAELEY, GURJIT (MD)
Entity Type:Individual
Prefix:
First Name:GURJIT
Middle Name:
Last Name:KAELEY
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:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP RHEUMATOLOGY DEPT.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035978207RR0500X
FLME101990207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8941604OtherSTATE CRIME VICTIMS
WA1116128Medicaid
WA8942004OtherSTATE CRIME VICTIMS
FL0005687-00Medicaid
WA0209656OtherSTATE L&I
WA0209658OtherSTATE L&I
FL0005687-00Medicaid
FLBI267ZMedicare PIN
FLP00755706Medicare PIN
WA0209658OtherSTATE L&I
WAG8864442Medicare PIN