Provider Demographics
NPI:1841322104
Name:KRISHNA IYER, JAYAM K (MD)
Entity type:Individual
Prefix:
First Name:JAYAM
Middle Name:K
Last Name:KRISHNA IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYAM
Other - Middle Name:K
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1012 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5606
Mailing Address - Country:US
Mailing Address - Phone:727-443-4242
Mailing Address - Fax:727-441-1158
Practice Address - Street 1:1012 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5606
Practice Address - Country:US
Practice Address - Phone:727-443-4242
Practice Address - Fax:727-441-1158
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044742207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02235AMedicare ID - Type Unspecified
FL02235YMedicare PIN
FLD50409Medicare UPIN