Provider Demographics
NPI:1609871805
Name:CHOWDAPPA, JAYADEVA (MD)
Entity Type:Individual
Prefix:
First Name:JAYADEVA
Middle Name:
Last Name:CHOWDAPPA
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 1:3535 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1811
Mailing Address - Country:US
Mailing Address - Phone:727-375-0848
Mailing Address - Fax:727-375-5548
Practice Address - Street 1:3535 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1811
Practice Address - Country:US
Practice Address - Phone:727-375-0848
Practice Address - Fax:727-375-5548
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL593554382174400000X
FLME73247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255619700Medicaid
FL44996Medicare ID - Type Unspecified
FL255619700Medicaid