Provider Demographics
NPI:1316914849
Name:BRIEVA, JAIRO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:
Last Name:BRIEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIRO
Other - Middle Name:ALVAREZ
Other - Last Name:BRIEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746636
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6636
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:841 PRUDENTIAL DR STE 180
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8350
Practice Address - Country:US
Practice Address - Phone:904-202-4243
Practice Address - Fax:904-202-4638
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000962222AMedicaid
FL2570378-00Medicaid
FL080189982Medicare PIN
FL2570378-00Medicaid
FL46701VMedicare PIN