Basic Information
Provider Information
NPI: 1447210018
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEJAR
FirstName: MIGUEL
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 44008
Address2: UFJP PROVIDER ENROLLMENT
City: JACKSONVILLE
State: FL
PostalCode: 322314008
CountryCode: US
TelephoneNumber: 9042443660
FaxNumber: 9042443425
Practice Location
Address1: 655 W 8TH ST
Address2: UFJP ANESTHESIA DEPT
City: JACKSONVILLE
State: FL
PostalCode: 322096511
CountryCode: US
TelephoneNumber: 9042444195
FaxNumber: 9042444908
Other Information
ProviderEnumerationDate: 03/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME80815FLY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home