Provider Demographics
NPI:1619968997
Name:SUROW, JASON BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BARRY
Last Name:SUROW
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 1:8808 RUM RUNNER PL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2206
Mailing Address - Country:US
Mailing Address - Phone:201-739-8684
Mailing Address - Fax:
Practice Address - Street 1:8808 RUM RUNNER PL
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-2206
Practice Address - Country:US
Practice Address - Phone:201-739-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148694207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
506579BMKMedicare PIN
NJC60960Medicare UPIN
NYA400011354Medicare PIN