Provider Demographics
NPI:1417960378
Name:ASLANIAN, JACOB R (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:R
Last Name:ASLANIAN
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1650 OSPREY AVE S.
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2928
Practice Address - Country:US
Practice Address - Phone:941-917-7760
Practice Address - Fax:941-917-8782
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME433062084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270920100Medicaid
FL650455689OtherFEDERAL ID
FL58433OtherBCBS
FLD56967Medicare UPIN
FL58433ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL58433OtherBCBS