Provider Demographics
NPI:1467435339
Name:JAIN, TARUN (MD)
Entity Type:Individual
Prefix:
First Name:TARUN
Middle Name:
Last Name:JAIN
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 1:3765 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5152
Mailing Address - Country:US
Mailing Address - Phone:321-507-4572
Mailing Address - Fax:321-507-4411
Practice Address - Street 1:3765 KINGS HWY
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5152
Practice Address - Country:US
Practice Address - Phone:321-507-4572
Practice Address - Fax:321-507-4411
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000098200Medicaid
FL000098200Medicaid