Provider Demographics
NPI:1780292326
Name:MITTAL, JAYESH (MD)
Entity type:Individual
Prefix:
First Name:JAYESH
Middle Name:
Last Name:MITTAL
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 1:2640 E BARNETT RD # E333
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4301
Mailing Address - Country:US
Mailing Address - Phone:541-282-6770
Mailing Address - Fax:541-282-6771
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-282-6770
Practice Address - Fax:541-282-6771
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD214478208M00000X
MI4351046212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist