Provider Demographics
NPI:1750494159
Name:RANAWAT, JAYANT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANT
Middle Name:
Last Name:RANAWAT
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 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-828-8739
Practice Address - Street 1:609 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1844
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:727-828-8739
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275397900Medicaid
FLAC354XMedicare PIN