Provider Demographics
NPI:1093873754
Name:ASHIZAWA, TETSUO (MD)
Entity Type:Individual
Prefix:
First Name:TETSUO
Middle Name:
Last Name:ASHIZAWA
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-5550
Mailing Address - Fax:352-273-5575
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5550
Practice Address - Fax:352-273-5575
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE67172084N0400X
FLME1050322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117744604Medicaid
1093873754OtherNATIONAL PROVIDER IDENTIFICATION
1093873754OtherNATIONAL PROVIDER IDENTIFICATION
TX00R518Medicare PIN
TX8D2289Medicare PIN
TX117744604Medicaid
TXCI5830Medicare PIN
1093873754OtherNATIONAL PROVIDER IDENTIFICATION
TX8689N8Medicare ID - Type Unspecified
TXC12989Medicare UPIN
TX00289YMedicare PIN