Provider Demographics
NPI:1679095640
Name:MEJIA-ESCOBAR, JAIME ALPHONSO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ALPHONSO
Last Name:MEJIA-ESCOBAR
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 1:6701 TOMY LEE TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1670
Mailing Address - Country:US
Mailing Address - Phone:850-445-0735
Mailing Address - Fax:
Practice Address - Street 1:6701 TOMY LEE TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-1670
Practice Address - Country:US
Practice Address - Phone:850-445-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor