Individual
BASHYAM IYENGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1760 EDGEWOOD AVE W STE B, SUITE B, JACKSONVILLE, FL 32208-7209
(904) 358-8480
(904) 358-8460
Mailing address
1760 EDGEWOOD AVE W STE B, SUITE B, JACKSONVILLE, FL 32208-7209
(904) 358-8480
(904) 358-8460
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
255281-1
NY
207Q00000X
Family Medicine Physician
25MA08303600
NJ
207Q00000X
Family Medicine Physician
MD60189759
WA
207Q00000X
Family Medicine Physician
Primary
ME110643
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003130827A
—
GA
05
—
008479700
—
FL
01
—
14P8Z
BCBS
FL
Enumeration date
11/04/2010
Last updated
05/22/2014
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