Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME74327 | FL |
N | 111NI0900X | Internist | ME74327 | FL |
Y | 207RH0000X | Hematologist | ME74327 | FL |
N | 207RX0202X | Medical Oncology | ME74327 | FL |
NPI | 1346266970 |
---|---|
Provider Name | Jyotishankar Raychaudhuri |
First Address | Miramar, FL 33025-3925 |
Second Address | Pembroke Pines, FL 33028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 18/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276000200 | (05) | FL |
56279 | BLUE CROSS BLUE SHIELD (01) | FL |
H86860 | (02) | FL |