Provider Demographics
NPI:1770503385
Name:WALAVALKAR, JYOTI RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:RAJEEV
Last Name:WALAVALKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500N HIGHWAY 89
Mailing Address - Street 2:NORTHERN ARIZONA VA HEALTH CARE SYTEMS ,
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313
Mailing Address - Country:US
Mailing Address - Phone:928-445-4860
Mailing Address - Fax:
Practice Address - Street 1:500N HWY 89
Practice Address - Street 2:NORTHERN ARIZONA VA HEALTH CARE SYSTEM
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059502207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine