Provider Demographics
NPI:1619104486
Name:JASIN, HUGO M (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGO
Middle Name:M
Last Name:JASIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3409
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1325
Practice Address - Street 1:12780 RACE TRACK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1395
Practice Address - Country:US
Practice Address - Phone:813-792-8878
Practice Address - Fax:813-443-8171
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113748208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9763896OtherAETNA
FL007904600Medicaid
FL14NJ5OtherBCBS