Provider Demographics
NPI:1245276096
Name:JAGALUR, THUMATI G (MD)
Entity type:Individual
Prefix:
First Name:THUMATI
Middle Name:G
Last Name:JAGALUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:1050 OLD CAMP RD STE 100
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:844-884-9355
Practice Address - Fax:352-674-8960
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256334700Medicaid
FL5191266OtherAETNA
FLP00068711OtherMEDICARE RAILROAD
31587OtherBCBS
FL2591363OtherGHI
FLP00068711OtherMEDICARE RAILROAD
31587OtherBCBS