Provider Demographics
NPI:1467860106
Name:JAIDEEP PURI MD PLLC
Entity Type:Organization
Organization Name:JAIDEEP PURI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-953-7451
Mailing Address - Street 1:221 GREENWICH CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 GREENWICH CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2890
Practice Address - Country:US
Practice Address - Phone:561-694-1021
Practice Address - Fax:561-694-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty