Provider Demographics
NPI:1750848727
Name:VARENDRA JAMWANT DPM
Entity Type:Organization
Organization Name:VARENDRA JAMWANT DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VARENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMWANT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-259-2159
Mailing Address - Street 1:PO BOX 771004
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34777-1004
Mailing Address - Country:US
Mailing Address - Phone:352-259-2159
Mailing Address - Fax:
Practice Address - Street 1:3105 CITRUS TOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6892
Practice Address - Country:US
Practice Address - Phone:352-259-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty