Provider Demographics
NPI:1780072942
Name:JYOTI, BABITA (MD)
Entity type:Individual
Prefix:
First Name:BABITA
Middle Name:
Last Name:JYOTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10881 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6612
Mailing Address - Country:US
Mailing Address - Phone:904-260-3022
Mailing Address - Fax:904-260-3947
Practice Address - Street 1:10881 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6612
Practice Address - Country:US
Practice Address - Phone:904-260-3022
Practice Address - Fax:904-260-3947
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN205112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME129707OtherSTATE LICENSE