Individual
RAXITKUMAR JINJUVADIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3635 CLYDE MORRIS BLVD STE 100, PORT ORANGE, FL 32129-2349
(386) 788-1242
(386) 756-8802
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301093965
MI
207RG0100X
Gastroenterology Physician
4301093965
MI
207RG0100X
Gastroenterology Physician
Primary
ME151069
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111664400
—
FL
Enumeration date
06/18/2009
Last updated
10/06/2021
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