Basic Information
| Provider Information | |||||||||
| NPI: | 1386612869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCHAND | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3319 S STATE ROAD 7 STE 109 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334498099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617985437 | ||||||||
| FaxNumber: | 3056623723 | ||||||||
| Practice Location | |||||||||
| Address1: | 3319 S STATE ROAD 7 STE 109 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334498099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617985437 | ||||||||
| FaxNumber: | 3056623723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME0068890 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | ME68890 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 252469400 | 05 | FL | MEDICAID | 32292 | 01 | FL | BCBS | OTHER | 930061912 | 01 | RAILROAD MEDICARE | OTHER | 2524694 | 05 | FL | MEDICAID |