Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | ME57658 | FL |
NPI | 1750360046 |
---|---|
Provider Name | Vidya Sagar Jain |
First Address | Palatka, FL 32177 |
Second Address | Palatka, FL 32177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 04/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063376300 | (05) | FL |
A64611 | (02) |