Provider Demographics
NPI:1861965386
Name:MISRA, JAIDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:JAIDEEP
Middle Name:
Last Name:MISRA
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 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:866-682-4842
Mailing Address - Fax:
Practice Address - Street 1:3940 SANDPIPER AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8372
Practice Address - Country:US
Practice Address - Phone:866-682-4842
Practice Address - Fax:877-436-1488
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA175930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine