Provider Demographics
NPI:1154666139
Name:HATGIS, JESSE MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:MICHAEL
Last Name:HATGIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 N UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2902
Mailing Address - Country:US
Mailing Address - Phone:954-720-3188
Mailing Address - Fax:954-722-6996
Practice Address - Street 1:7171 N UNIVERSITY DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-720-3188
Practice Address - Fax:954-722-6996
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 3325208100000X
FLOS12339208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation