Provider Demographics
NPI:1225070832
Name:J T ERWIN MD PA
Entity Type:Organization
Organization Name:J T ERWIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:T
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-863-5242
Mailing Address - Street 1:12843 US HWY 19
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-863-5242
Mailing Address - Fax:727-868-0823
Practice Address - Street 1:12843 US HWY 19
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-863-5242
Practice Address - Fax:727-868-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85915Medicare UPIN
FLK0375Medicare ID - Type Unspecified