Provider Demographics
NPI:1083673370
Name:POKLEPOVIC, JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:POKLEPOVIC
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 1:2700 UNIVERSITY SQUARE DRIVE
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:
Practice Address - Street 1:2700 UNIVERSITY SQUARE DRIVE
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-251-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME203862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066614900Medicaid
AL118707Medicaid
FL29757Medicare PIN
FL29757KMedicare PIN
FLD53706Medicare UPIN
FL300021278Medicare PIN
FL29757JMedicare PIN
FL300024410Medicare PIN
FL300093617Medicare PIN
FL300125440Medicare PIN