Provider Demographics
NPI:1871750299
Name:MANUEL G JAIN, MD, LLC
Entity type:Organization
Organization Name:MANUEL G JAIN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REP ASSIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-685-2191
Mailing Address - Street 1:321 E ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5253
Mailing Address - Country:US
Mailing Address - Phone:813-685-2191
Mailing Address - Fax:
Practice Address - Street 1:105 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-2844
Practice Address - Country:US
Practice Address - Phone:863-422-8404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58688Medicare UPIN