Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 273186 | NY |
Y | 2081P2900X | Pain Medicine | ME 122237 | FL |
NPI | 1255625513 |
---|---|
Provider Name | Dr. Navdeep Singh Jassal |
First Address | Lakeland, FL 33805-3208 |
Second Address | Lakeland, FL 33805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2011 |
Last Update Date | 31/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015208900 | (05) | FL |
150HR | BCBS (01) | FL |
P01510619 | RR MCR (01) | FL |