Provider Demographics
NPI:1750360046
Name:JAIN, VIDYA SAGAR (MD)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:SAGAR
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-325-7711
Mailing Address - Fax:386-325-3020
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:STE 100
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-325-7711
Practice Address - Fax:386-325-3020
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME576582086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063376300Medicaid
FL063376300Medicaid
FL10681Medicare ID - Type Unspecified