Provider Demographics
NPI:1407044258
Name:WASSERMAN, JESSICA E B (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:E B
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5955 RAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5160
Mailing Address - Country:US
Mailing Address - Phone:941-552-7508
Mailing Address - Fax:941-552-7605
Practice Address - Street 1:5955 RAND BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5160
Practice Address - Country:US
Practice Address - Phone:941-552-7508
Practice Address - Fax:941-552-7605
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-9057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H40037Medicare UPIN