Individual
MR. JAY C CHANMUGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1133 SAXON BLVD, ORANGE CITY, FL 32763-8425
(386) 228-9700
Mailing address
1133 SAXON BLVD, ORANGE CITY, FL 32763-8425
(386) 878-4137
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS8600
FL
208D00000X
General Practice Physician
OS8600
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106634
AMERIGROUP
FL
05
—
267573100
—
FL
01
—
71397
BLUE CROSS
FL
Enumeration date
06/03/2006
Last updated
11/28/2022
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