Basic Information
| Provider Information | |||||||||
| NPI: | 1669444725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CESARETTI | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7017 A C SKINNER PARKWAY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045206800 | ||||||||
| FaxNumber: | 9045206801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1561 W FAIRBANKS AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327894678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074784920 | ||||||||
| FaxNumber: | 4074784921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | ME102354 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 2233361 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000285800 | 05 | FL | MEDICAID | 318866 | 01 | FL | AVMED | OTHER | 53300 | 01 | FL | BCBS OF FL | OTHER | 02637534 | 05 | NY | MEDICAID |