Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME57515 | FL |
N | 111NI0900X | Internist | ME57515 | FL |
Y | 207RX0202X | Medical Oncology | ME57515 | FL |
NPI | 1144225939 |
---|---|
Provider Name | Jaydev H Avashia |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Davenport, FL 33837-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063384400 | (05) | FL |
10719 | BLUE CROSS BLUE SHIELD (01) | FL |
E59990 | (02) | FL |