Provider Demographics
NPI:1518912112
Name:PULASKI, JAIME JOE (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:JOE
Last Name:PULASKI
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 1:12101 SHADY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5630
Mailing Address - Country:US
Mailing Address - Phone:813-672-3371
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:SUITE: A-327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3508
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93634207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34077OtherFL BCBS
FL7597788OtherAETNA
FLP00281769OtherMEDICARE RAILROAD
FL7597788OtherAETNA
FLP00281769OtherMEDICARE RAILROAD
FL34077YMedicare ID - Type UnspecifiedFTGBA MEDICARE
FL34077Medicare PIN