Provider Demographics
NPI:1780814988
Name:CANADAY AND JAGEDO PHYSICIAN ASSOCIATES PL
Entity Type:Organization
Organization Name:CANADAY AND JAGEDO PHYSICIAN ASSOCIATES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:CANADAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-325-1157
Mailing Address - Street 1:700 ZEAGLER DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6806
Mailing Address - Country:US
Mailing Address - Phone:386-325-1157
Mailing Address - Fax:386-325-1161
Practice Address - Street 1:700 ZEAGLER DR
Practice Address - Street 2:SUITE 6
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6806
Practice Address - Country:US
Practice Address - Phone:386-325-1157
Practice Address - Fax:386-325-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102632208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty