Provider Demographics
NPI:1023446283
Name:JAIME H MEJIA MD PA
Entity type:Organization
Organization Name:JAIME H MEJIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-805-9494
Mailing Address - Street 1:2619 SHOEMAKER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6701
Mailing Address - Country:US
Mailing Address - Phone:954-805-9494
Mailing Address - Fax:
Practice Address - Street 1:2619 SHOEMAKER LN
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6701
Practice Address - Country:US
Practice Address - Phone:954-805-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty