Provider Demographics
NPI:1780665216
Name:CASELLAS, JAIME F (MD PA)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:F
Last Name:CASELLAS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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 1:4600 N HABANA AVE
Practice Address - Street 2:SUIT 13
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7166
Practice Address - Country:US
Practice Address - Phone:813-878-2970
Practice Address - Fax:813-870-2294
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021457174400000X
FLME21457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055202000Medicaid
FL29801Medicare ID - Type Unspecified
FLD85476Medicare UPIN