Provider Demographics
NPI:1720010267
Name:JAHAN, ISRAT (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ISRAT
Middle Name:
Last Name:JAHAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 HIGHLANDS LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-619-9853
Mailing Address - Fax:813-631-7128
Practice Address - Street 1:JAMES A. HALEY VETERANS HOSPITAL
Practice Address - Street 2:13000 BRUCE B. DOWNS BLVD. (116A)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-631-7124
Practice Address - Fax:813-631-7128
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME941162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry