Provider Demographics
NPI:1629123906
Name:WAUGH, JASON ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
Last Name:WAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:6709 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6834
Practice Address - Country:US
Practice Address - Phone:727-248-0375
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0054788207R00000X
FLOS18078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0054788OtherCOLORADO STATE MEDICAL LICENSE