Provider Demographics
NPI:1346427309
Name:JAIN, SURBHI (MD)
Entity Type:Individual
Prefix:
First Name:SURBHI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-935-4210
Mailing Address - Fax:813-932-7940
Practice Address - Street 1:6919 N DALE MABRY HWY
Practice Address - Street 2:STE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-558-4900
Practice Address - Fax:813-558-2155
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103338207PE0005X, 2083P0011X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280613400Medicaid
FLP01655860OtherRAILROAD MEDICARE
FL26306OtherBLUE CROSS BLUE SHIELD
FL26306OtherBLUE CROSS BLUE SHIELD
FLP01655860OtherRAILROAD MEDICARE
FLAI921VMedicare PIN