Provider Demographics
NPI:1013902436
Name:VAISMAN, ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:VAISMAN
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2101 RIVERSIDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6260
Practice Address - Country:US
Practice Address - Phone:954-341-6200
Practice Address - Fax:954-341-6204
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00431722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL165336OtherWELLCARE PROVIDER #
FLQMP000003837485OtherMOLINA MCR
FL23531OtherBCBS PROVIDER NUMBER
FL3338532OtherCIGNA
FL5735OtherNHP THRU PMG PROVIDER #
FLNB436OtherFL HF MEDICARE
FL374094300Medicaid
FL6404OtherDIMENSION PROVIDER NUMBER
FL6404OtherDIMENSION HEALTH
FLP0003162OtherFLORIDA HEALTHCARE PLUS
FLQMP000003725630OtherMOLINA MCD
FL206646OtherAVMED PROVIDER NUMBER
FL215074OtherAMERIGROUP PROVIDER NUM.
FL4583391OtherAETNA PROVIDER NUMBER
FL786828OtherFIRST HEALTH PROVIDER #
FL4102221OtherGHI PROVIDER NUMBER
FL4416OtherTOTAL HLTH CH PROVIDER #
FL165336OtherWELLCARE
FLP00128OtherFREEDOM
FL165336OtherWELLCARE (MEDICARE AND MEDICAID)
FLP510124OtherOPTIMUM
FL4102221OtherGHI PROVIDER NUMBER
FL23531VMedicare PIN