Provider Demographics
NPI:1083834014
Name:JONATHAN A ADLER MD PA
Entity Type:Organization
Organization Name:JONATHAN A ADLER MD PA
Other - Org Name:JONATHAN A ADLER MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-753-0220
Mailing Address - Street 1:1509 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2866
Mailing Address - Country:US
Mailing Address - Phone:941-753-0220
Mailing Address - Fax:941-753-0279
Practice Address - Street 1:1509 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2866
Practice Address - Country:US
Practice Address - Phone:941-753-0220
Practice Address - Fax:941-753-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58865207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4257Medicare PIN