Provider Demographics
NPI:1699770990
Name:TRAINER, JOHN EZRA III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EZRA
Last Name:TRAINER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6841 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4418
Mailing Address - Country:US
Mailing Address - Phone:904-862-2175
Mailing Address - Fax:904-862-2175
Practice Address - Street 1:6841 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4418
Practice Address - Country:US
Practice Address - Phone:904-862-2175
Practice Address - Fax:904-862-2175
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80458207QA0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101586800Medicaid
FL58658YMedicare PIN
H41047Medicare UPIN