Provider Demographics
NPI:1457411100
Name:JAMINAL, MAR (MD)
Entity type:Individual
Prefix:
First Name:MAR
Middle Name:
Last Name:JAMINAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1155 E 21ST ST
Practice Address - Street 2:UFJP EASTSIDE FAMILY PRACTICE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-2401
Practice Address - Country:US
Practice Address - Phone:904-359-9067
Practice Address - Fax:904-360-9651
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00424072Medicare PIN
FLAE065ZMedicare PIN