Provider Demographics
NPI:1326085630
Name:WEISKOPF, JAY R (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:R
Last Name:WEISKOPF
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 1:7522 N HIMES AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3205
Mailing Address - Country:US
Mailing Address - Phone:813-931-0500
Mailing Address - Fax:931-935-4055
Practice Address - Street 1:7522 N HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3205
Practice Address - Country:US
Practice Address - Phone:813-931-0500
Practice Address - Fax:931-935-4055
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114837207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2514713570003OtherCIGNA
463407OtherAETNA
463407OtherAETNA
2514713570003OtherCIGNA