Provider Demographics
NPI:1790916369
Name:EDGARD JANER MD PA
Entity Type:Organization
Organization Name:EDGARD JANER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-962-4119
Mailing Address - Street 1:PO BOX 342159
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694
Mailing Address - Country:US
Mailing Address - Phone:813-962-4119
Mailing Address - Fax:813-962-3278
Practice Address - Street 1:3411 W FLETCHER AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2813
Practice Address - Country:US
Practice Address - Phone:813-962-4119
Practice Address - Fax:813-962-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065277207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253149600Medicaid
FL28382Medicare PIN
FLG-30164Medicare UPIN