Organization
CLINIC FOR KIDNEY DISEASES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DINESH JAYADEVAPPA MD (PRESIDENT)
(904) 388-2678
Entity
Organization
Contact information
Practice address
2585 HERSCHEL ST, JACKSONVILLE, FL 32204-4557
(904) 388-2678
(904) 388-6776
Mailing address
2585 HERSCHEL ST, JACKSONVILLE, FL 32204-4557
(904) 388-2678
(904) 388-6776
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME24762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255215900
—
FL
01
—
99457
BCBS GROUP #
FL
Enumeration date
07/19/2006
Last updated
01/20/2010
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