Provider Demographics
NPI:1770534802
Name:MAYER, JENNIFER ROOT (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROOT
Last Name:MAYER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:DEPT 6941
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:DEPT 6941
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4429
Practice Address - Fax:727-767-4970
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68106208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379718000Medicaid
FLG38003Medicare UPIN