Provider Demographics
NPI:1982815288
Name:KLEIN, JESSE J (DO)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W BAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2282
Mailing Address - Country:US
Mailing Address - Phone:727-581-3550
Mailing Address - Fax:727-586-6190
Practice Address - Street 1:1345 W BAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2282
Practice Address - Country:US
Practice Address - Phone:727-581-3550
Practice Address - Fax:727-586-6190
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10628207RC0000X
FLOS 10628207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001094700Medicaid
FLCA735ZMedicare PIN