Provider Demographics
NPI:1528053162
Name:RAO, JAYANTH G (MD)
Entity type:Individual
Prefix:
First Name:JAYANTH
Middle Name:G
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3406 N LECANTO HWY.
Practice Address - Street 2:SUITE A
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3548
Practice Address - Country:US
Practice Address - Phone:352-746-1100
Practice Address - Fax:352-422-7023
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 654652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25903OtherBCBS OF FL
FL103495OtherAVMED
FL25903OtherBCBS
FLP00056OtherFREEDOM HEALTH
FLP00909691OtherRR MEDICARE
FLP01254190OtherRAILROAD MCR
FLP201226OtherOPTIMUM
FL2486569OtherCIGNA
FL5002104OtherAETNA
FLP502641Medicaid
FL346441900Medicaid
FL937635OtherWELLCARE
FL25903WMedicare PIN
FL346441900Medicaid
FL25903UMedicare PIN
FLP00909691OtherRR MEDICARE
FL25903OtherBCBS OF FL