Provider Demographics
NPI:1932355971
Name:RATHORE, JAIVIR SINGH (MD, FAES)
Entity type:Individual
Prefix:DR
First Name:JAIVIR
Middle Name:SINGH
Last Name:RATHORE
Suffix:
Gender:M
Credentials:MD, FAES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 METROWEST BLVD STE 104-105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7629
Mailing Address - Country:US
Mailing Address - Phone:407-365-3033
Mailing Address - Fax:407-365-3034
Practice Address - Street 1:6000 METROWEST BLVD STE 104-105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7629
Practice Address - Country:US
Practice Address - Phone:407-365-3033
Practice Address - Fax:407-365-3034
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1425062084N0400X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104167800Medicaid