Provider Demographics
NPI:1144430992
Name:JAIN, AMIT (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 ONE HEALING PLACE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-5360
Mailing Address - Fax:850-431-5367
Practice Address - Street 1:1775 ONE HEALING PLACE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-431-5360
Practice Address - Fax:850-431-5367
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7754207R00000X
IN01066391A207RH0003X
FLME112407207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00708618OtherRR MEDICARE
IA71926036Medicare PIN