Provider Demographics
NPI:1669444725
Name:CESARETTI, JAMIE A (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:CESARETTI
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 1:7017 A C SKINNER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-520-6800
Mailing Address - Fax:904-520-6801
Practice Address - Street 1:1561 W FAIRBANKS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4678
Practice Address - Country:US
Practice Address - Phone:407-478-4920
Practice Address - Fax:407-478-4921
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1023542085R0001X
NY22333612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000285800Medicaid
FL318866OtherAVMED
FL53300OtherBCBS OF FL
NY02637534Medicaid
FLAM118WMedicare PIN
FLAM118FMedicare PIN
NYA400079524Medicare PIN
FLAM118YMedicare PIN
NY02637534Medicaid
FLAM118XMedicare PIN
FLAM118UMedicare PIN
FL318866OtherAVMED
I23908Medicare UPIN
FL000285800Medicaid
FLAM118NMedicare PIN