Provider Demographics
NPI:1518925742
Name:AGSALUD, JAYMIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYMIE
Middle Name:
Last Name:AGSALUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1771
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:HRMC/HOSPITALIST PROGRAM
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-1771
Practice Address - Fax:321-434-1774
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102005207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBE697WOtherHFMG MA
FLME102005OtherLICENSE
FL000589700Medicaid