Provider Demographics
NPI:1598868069
Name:ROY, ASOK KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ASOK
Middle Name:KUMAR
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASOK
Other - Middle Name:KUMAR
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17577
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7577
Mailing Address - Country:US
Mailing Address - Phone:904-399-1623
Mailing Address - Fax:904-399-1624
Practice Address - Street 1:3720 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3814
Practice Address - Country:US
Practice Address - Phone:904-399-1623
Practice Address - Fax:904-399-1624
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI31786207R00000X, 207RA0401X, 207RC0000X, 207RG0100X, 207RG0300X
FLME99452207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002831500Medicaid
FL002831500Medicaid
FLBS231UMedicare PIN
MI0639301Medicare PIN