1417908435 NPI number — MIGUEL JURADO MD

Table of content: MIGUEL JURADO MD (NPI 1417908435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417908435 NPI number — MIGUEL JURADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JURADO
Provider First Name:
MIGUEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417908435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000-2 LEM TURNER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-539-8200
Provider Business Mailing Address Fax Number:
904-539-8229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000-2 LEM TURNER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-539-8200
Provider Business Practice Location Address Fax Number:
904-539-8229
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME162602 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007065498 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00337029 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 949593-09859 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com