Provider Demographics
NPI:1659395309
Name:YASOVA, MORRIS M (CPO)
Entity Type:Individual
Prefix:MR
First Name:MORRIS
Middle Name:M
Last Name:YASOVA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 TAMPA ROAD
Mailing Address - Street 2:STE H
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683
Mailing Address - Country:US
Mailing Address - Phone:727-786-0880
Mailing Address - Fax:727-786-0882
Practice Address - Street 1:2445 TAMPA ROAD
Practice Address - Street 2:STE H
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683
Practice Address - Country:US
Practice Address - Phone:727-786-0880
Practice Address - Fax:727-786-0882
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR57222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL952069400Medicaid
FL1030710001Medicare ID - Type Unspecified