Provider Demographics
NPI:1982641494
Name:JAZAREVIC, SLOBODAN (MD)
Entity Type:Individual
Prefix:
First Name:SLOBODAN
Middle Name:
Last Name:JAZAREVIC
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 1:1720 SE 16TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4620
Mailing Address - Country:US
Mailing Address - Phone:352-369-0288
Mailing Address - Fax:
Practice Address - Street 1:1720 SE 16TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4620
Practice Address - Country:US
Practice Address - Phone:352-369-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME655702086S0102X, 208600000X, 2086S0129X, 2086S0127X
NY192322-1208600000X, 2086S0102X, 2086S0129X, 2086S0127X
CODR005524072086S0102X
CODR00524072086S0127X, 208600000X, 2086S0129X
NY192322208600000X, 2086S0120X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03487616OtherGROUP MEDICAID
FL277835100Medicaid
FL014768800Medicaid
NY03487616OtherGROUP MEDICAID