Provider Demographics
NPI:1306823851
Name:HAMBLIN, JEFFREY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:HAMBLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 197515
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-7515
Mailing Address - Country:US
Mailing Address - Phone:941-782-4391
Mailing Address - Fax:941-782-4301
Practice Address - Street 1:4010 SAWYER RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1272
Practice Address - Country:US
Practice Address - Phone:941-782-4150
Practice Address - Fax:941-782-4898
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2023-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI40945-0202084P0804X
NY2124042084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92775Medicare UPIN